079200827-4-15-2025-15-AS-KHOS-DG6JNG-20250428071156

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200827
Report Date: 04/15/2025
Date Signed: 04/15/2025 12:09:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/26/2024 and conducted by Evaluator Carol Fowler

COMPLAINT CONTROL NUMBER: 15-AS-20241126100312

FACILITY NAME:	LOVING HANDS CARE HOME LLC		FACILITY NUMBER:	079200827
ADMINISTRATOR:	SAN DIEGO-TOMAS, CECILIA		FACILITY TYPE:	740
ADDRESS:	748 VAQUEROS AVE		TELEPHONE:	(510) 245-3738
CITY:	RODEO	STATE: CA	ZIP CODE:	94572
CAPACITY:	6	CENSUS: 4	DATE:	04/15/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	EDELYN TUPAS, CAREGIVER		TIME COMPLETED:	12:07 PM

ALLEGATION(S):

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Staff are not properly feeding a resident
Staff are interfering with a resident's visitations

INVESTIGATION FINDINGS:

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On 04/15/2025 at 10:00am, Licensing Program Analyst (LPA), Carol Fowler arrived unannounced to deliver complaint findings for the allegations above. LPA met with Edelyn Tupas, Caregiver and explained the reason for the visit.

During the investigation LPA interviewed staff, conservator and resident. LPA obtained and reviewed physician report, appraisal needs and service plan, facility menus, photos of meals and snacks, text messages requesting food items from R1 to S1, email from conservator and visitor policy.

Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol Fowler	TELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20241126100312

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: LOVING HANDS CARE HOME LLC	FACILITY NUMBER: 079200827
	VISIT DATE: 04/15/2025

NARRATIVE

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Continue from LIC 9099

Allegation: Staff are not properly feeding a resident
Investigation Finding: unsubstantiated.

During interviews with resident R1 revealed R1 is not satisfied with the food the facility is serving, R1 stated that the facility is serving 1 slice of bread for lunch, sometimes Pilipino food and crackers, R1 stated the facility provided R1 with popcorn once and it tasted stale. R1 stated R1 has been eating trail mix, popcorn, licorice and chips, R1 stated the facility gave R1 hot peppers one time. R1 also stated that R1 is starving. Interview with S1 revealed that R1 has a conservator which will explain that R1 constantly complains about R1 care and food at the facility. S1 stated that the facility is serving American nutritious meals and S1 will go out and buy the food items and snacks requested by R1. S1 also stated that R1 likes to sleep until afternoon and wishes to have breakfast, lunch and dinner all at the same time. S1 stated R1 is eating all meals and snacks daily. S1 stated S1 takes photos of meals served and eaten by R1. Interview with W2 revealed that R1 has complained constantly about R1’s care at the facility and that R1 has called the public defender, APS, Legal Assistance for Seniors and multiple other agencies. W2 stated R1 claims are R1 is being starved, being poisoned and having funds and belongings stolen and various other abuses, W2 states that R1’s claims have never been substantiated. W2 also stated that caregivers have overlooked R1’s racial and fat-shaming slurs. W2 states R1’s actions are due to diagnosis. LPA was presented with photos of R1’s snacks, meals, texted food requests and facility menu. LPA did not observe any food being locked or inaccessible to residents. Therefore, this allegation is UNSUBSTANTIATED

Continue on LIC 9099C(2)

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol Fowler	TELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20241126100312

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: LOVING HANDS CARE HOME LLC	FACILITY NUMBER: 079200827
	VISIT DATE: 04/15/2025

NARRATIVE

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Continue from LIC 9099C

Allegation: Staff are interfering with a resident's visitations
Investigation Finding: unsubstantiated.

During the investigation LPA interviewed staff, conservator and resident. Interview with S1 revealed that visiting hours at the facility is 10:00am to 3:00pm. S1 stated that R1 was a part of the homeless population for over 10 years and R1’s friends are from the homeless population they are welcomed to visit and follow the facility policies, but they bring R1 over the counter drugs. During COVID a friend would not follow COVID guidelines being vaccinated or tested and R1 is not vaccinated. R1 has only a few visitors and a few visitors have restraining orders and are turned away. Interview with W2 revealed that R1 has been homeless for decades and most of R1’s friends can’t make the trip to visit R1 in Rodeo. There are also some friends of R1’s that have restraining orders and are not allowed to visit the facility. W2 stated that R1 has two phones to reach out to friends. W2 stated that R1 has an attorney, and the attorney is well aware of R1’s history and background. Therefore, this allegation is UNSUBSTANTIATED

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol Fowler	TELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

LIC9099 (FAS) - (06/04)

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