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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601041
Report Date: 10/25/2024
Date Signed: 10/28/2024 09:12:47 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/28/2024 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20240328084808
FACILITY NAME:GINES RESIDENTIAL CARE HOME IIIFACILITY NUMBER:
075601041
ADMINISTRATOR:GINES, ERLINDAFACILITY TYPE:
740
ADDRESS:2565 STONE VALLEY ROADTELEPHONE:
(925) 743-1146
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 3DATE:
10/25/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee, Erlinda GinesTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not report incident(s) regarding resident(s) in care.
Staff did not prevent resident from being financially abused while in care.
Staff did not adequately address resident's change in condition.
INVESTIGATION FINDINGS:
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On 10/25/2024 at 9:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct a complaint visit and deliver findings. LPA explained the purpose of the visit to Licensee, Erlinda Gines.

During visit LPA interviewed Erlinda as no prior staff works at the facility. On the allegation of "Staff did not report incident(s) regarding resident(s) in care" The investigation found that staff at the facility did not properly report critical incidents concerning Resident 1 (R1). Specifically, the staff failed to report that R1’s designated Power of Attorney (POA) was missing and unresponsive, a situation that left R1 vulnerable to financial and decision-making exploitation. The administrator acknowledged, they knew the POA was not paying and wasn’t reachable, but did not file a formal report about the missing POA.

Report continues on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 15-AS-20240328084808
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: GINES RESIDENTIAL CARE HOME III
FACILITY NUMBER: 075601041
VISIT DATE: 10/25/2024
NARRATIVE
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Additionally, despite noticing changes in R1’s health condition, the staff failed to notify R1’s physician, as required. The administrator admitted, “I did not contact the physician because I was told that the niece was the main point of contact,” which directly contributed to gaps in R1’s medical care and oversight. Therefore the allegation is SUBSTANTIATED

On the allegation "Staff did not prevent resident from being financially abused while in care" it was found that staff were aware of financial issues involving R1 as early as November 2023 but did not act promptly to prevent further financial abuse. The administrator admitted, “We knew the POA was not paying, and the niece would sometimes pay R1’s rent,” but a financial abuse report was not filed until March 22, 2024. Additionally, despite being advised to contact Adult Protective Services (APS), staff did not make an immediate report. The administrator further acknowledged that “we waited too long to do anything because we were trying to be nice and help R1,” which resulted in prolonged financial vulnerability for R1. Therefore the allegation is SUBSTANTIATED.

On the allegation "Staff did not adequately address resident's change in condition" it was found that Staff failed to respond adequately to changes in R1’s health condition. The administrator disclosed that R1’s niece, who was not the designated Power of Attorney (POA), was making significant healthcare decisions on R1’s behalf. When asked about this, the administrator stated, “We listened to the niece and let her make decisions for R1, even when R1 had a change in condition.” This deference to an unauthorized individual led to a delay in medical intervention. Staff was unable to adequately provide care to the resident because of the condition change. The administrator admitted that she did not notify R1’s physician, explaining, “I was told that the niece was the main point of contact.” However, there was no POA documentation stating that the niece could make decisions for R1. Therefore the allegation is SUBSTANTIATED.

LPA also obtained POA documentation along with other documents for R1. LPA was unable to make contact with R1 or any responsible parties for R1.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/28/2024 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20240328084808

FACILITY NAME:GINES RESIDENTIAL CARE HOME IIIFACILITY NUMBER:
075601041
ADMINISTRATOR:GINES, ERLINDAFACILITY TYPE:
740
ADDRESS:2565 STONE VALLEY ROADTELEPHONE:
(925) 743-1146
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 3DATE:
10/25/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee, Erlinda GinesTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Licensee did not follow proper eviction procedures for resident in care.
INVESTIGATION FINDINGS:
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On 10/25/2024 at 9:50 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct a complaint visit and deliver findings. LPA explained the purpose of the visit to Licensee, Erlinda Gines.

Through interview and record review the allegation of "Licensee did not follow proper eviction procedures for resident in care" it was found that the facility initiated the appropriate eviction process when R1’s designated Power of Attorney failed to make required rent payments. LPA did receive a request for an eviction for R1 due to non-payment, and LPA approved the letter. The facility issued a 30-day eviction notice as required, and R1 remained at the facility during this period. However, R1 was removed from the facility by a relative without notice. This removal does not indicate a failure to follow eviction procedures therefore the allegation is UNSUBSTANTIATED.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20240328084808
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: GINES RESIDENTIAL CARE HOME III
FACILITY NUMBER: 075601041
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2024
Section Cited
CCR
87211a(1)
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a)Each licensee shall furnish...the following:(1)A written report shall be submitted...within seven days of the occurrence of any of the events ...

This requirement was not met as evidence by:
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R1 no longer resides at the facility. Administrator has reviewed the regulations and has started documenting according to regulations. POC cleared.
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Based on file review and interview the Licensee did not report incidents regarding R1 in a timely manner which posed a potential health and personal rights risk to resident in care.
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Type B
10/25/2024
Section Cited
CCR
87466
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The licensee shall ensure that residents are regularly observed... When changes ... are observed, the licensee shall ensure that such changes are ... brought to the attention of the resident's physician and the resident's responsible person, if any.
This requirement was not met as evidence by:
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R1 no longer resides at the facility. Administrator has reviewed the regulations and has started documenting according to regulations. POC cleared.
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Based on file review and interview the Licensee did not report changes in R1's condition to the appropiate persons which posed a potential safety and personal rights risk to resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20240328084808
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: GINES RESIDENTIAL CARE HOME III
FACILITY NUMBER: 075601041
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2024
Section Cited
CCR
87468.2(a)(8)
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(a) In addition to the rights listed in Section 87468.1,...Residents... privately operated ... shall have...(8)To be free from...financial exploitation...abuse.

This requirement was not met as evidence by:
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R1 no longer resides at the facility. Administrator reviewed the regulations and confirmed to LPA that they now understand what is expected. POC cleared
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Based on interview with Administrator they did not stop R1 from being financialy abused which posed an imediate personal rights risk to resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5