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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601041
Report Date: 10/30/2025
Date Signed: 10/30/2025 12:02:58 PM

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
10/22/2025 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20251022124253
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: 4DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Adminstrator, Erlinda GinesTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff are not meeting residents needs
INVESTIGATION FINDINGS:
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On 10/30/2025, at 9:30 AM, Licensing Program Analysts (LPAs) A Gomez and Y Brown arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings concerning the allegations above. Upon entry, the LPAs informed staff 2 (S2) of the reason for the visit. Licensee/ Administrator Erlinda Gines was notified and arrived at 10:14 AM.

LPAs conducted interviews, toured facility, reviewed camera footage, and reviewed documets.

Report continues on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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
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
10/22/2025 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20251022124253

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: 4DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Adminstrator, Erlinda GinesTIME COMPLETED:
12:20 PM
ALLEGATION(S):
1
2
3
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5
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8
9
Staff are not providing adequate food service to resident's
INVESTIGATION FINDINGS:
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5
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9
10
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13
On 10/30/2025, at 9:30 AM, Licensing Program Analysts (LPAs) A Gomez and Y Brown arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings concerning the allegations above. Upon entry, the LPAs informed staff 2 (S2) of the reason for the visit. Licensee/ Administrator Erlinda Gines was notified and arrived at 10:14 AM.

LPAs conducted interviews, toured facility, reviewed camera footage, and reviewed documets.

Report continues on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20251022124253
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: 10/30/2025
NARRATIVE
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LPAs observed that there is adequate food and snacks of good quality available to residents. LPAs also observed that at the time of the visit residents where served lunch at approximately 11:30am that consisted of homemade ground beef stew that included ground beef, tomato paste, peas, potatoes, and onions. LPAs also observed that residents with a puree diet were served a puree of bread, rice, ground beef, tomato paste, peas, potatoes, and onions. Therefore the allegation Staff are not providing adequate food service to resident's 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.

exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20251022124253
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: 10/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2025
Section Cited
CCR
87411(a)
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(a) Facility personnel shall at all times be sufficient in numbers...to meet resident needs...of adequate services.

This requirement is not met as evidence by
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By POC facility agrees to update their staff schedules and notify CCLD
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Based on observations of facility cameras LPAs observed R2 wandering the facility nude from the waist down at approximately 3:30am on 10/30/2025 as well as R3 wandering around at the same time frame. Both residents have wandering behaviors noted in their files. No staff responded to the residents movments which poses a potential personal rights and safety risk to residents 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.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 15-AS-20251022124253
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: 10/30/2025
NARRATIVE
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LPAs observed that on 10/30/2025 at around 3:30AM R2 was wandering the facility nude from the waist down and R3 was also wandering the facility at the same time. No staff responded to R2 or R3. LPA's also interviewed Administrator and S1 and found that there is not a set schedule for Staff and Staff checks of residents primarily in the evening. LPAs observed in R2 and R3's files that they both have documented wandering behavior. LPA's also found through interview and review of camera footage that residents requiring incontinence care are having as much as a 12 hour gap between having their incontinence changed (6pm-6am). Therefore the allegation of Staff are not meeting residents needs is Substantiated.



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.

Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5