011400061-1-6-2026-15-AS-BFOG-DTNMUW-20260501095551

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 011400061
Report Date: 01/06/2026
Date Signed: 01/06/2026 06:35:25 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
01/05/2026 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20260105105331

FACILITY NAME:	BETHESDA HOME		FACILITY NUMBER:	011400061
ADMINISTRATOR:	DAVID R. MARTINEZ		FACILITY TYPE:	740
ADDRESS:	22427 MONTGOMERY		TELEPHONE:	(510) 538-8300
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	28	CENSUS: 0	DATE:	01/06/2026
		UNANNOUNCED	TIME BEGAN:	04:10 PM
MET WITH:	Roselyn Chand/Administrator		TIME COMPLETED:	06:40 PM

ALLEGATION(S):

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Staff yelled at resident.
Staff forced residents to sign unknown documents.
Staff did not provide residents dignity in their personal relationship.
Staff did not follow resident's doctor recommended dietary needs.
Staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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On this day, 1/06/26, Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegations. LPA met with Roselyn Chand, administrator (ADM), and informed the reason for visit.

During the course of investigation, LPA reviewed and obtained copies of resident (R1) documents including but not limited to LIC602A Physician's Report, LIC625 Appraisal/Needs and Services Plan, R1's glucose readings. LPA also obtained copies of menu and kitchen's list for R1 showing R1 is diabetic.

LPA interviewed the reporting party (RP), R1 and staff (S1, S2 and ADM).

....continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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 3

Control Number 15-AS-20260105105331

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: BETHESDA HOME	FACILITY NUMBER: 011400061
	VISIT DATE: 01/06/2026

NARRATIVE

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Allegation: Staff yelled at resident (R1).
The reporting party (RP) reported that ADM yelled at R1; however, during interview by LPA, RP stated not observing ADM yelled at R1. R1 stated ADM yelled at him but ADM denied the allegation. S1 and S2 stated not observing ADM yelled at R1 and other residents. Therefore, the allegation is unsubstantiated.

Allegation: Staff forced residents to sign unknown documents.
RP stated that ADM forced the residents to sign documents and that it happened when RP was not at the facility. R1 stated he was forced to sign document without allowing to read first and was not given a copy. ADM denied the allegation. ADM stated that residents were given the LIC625 Appraisal/Needs and Services Plan to sign and residents were given copies. There was only one resident who refused to sign and documents which were required to be provided to the Department. Both S1 and S2 stated not observing ADM forced any resident sign document. S1 stated whenever residents asked for copies of documents, they are provided. Therefore, the allegation is unsubstantiated.

Allegation: Staff did not provide residents dignity in their personal relationship.
RP stated that ADM told her and R1 they can not have relationship and that the relationship is toxic. R1 stated that ADM told them they cannot have relationship, however, ADM denied the allegation. S1 and S2 stated not hearing ADM tell RP and R1 such and that residents have rights to have personal relationship. Therefore, the allegation in unsubstantiated.

Allegation: Staff did not follow resident's doctor recommended dietary needs.
RP stated the facility did not follow R1's diabetic diet and observed the staff gave R1 sugar cookies, pudding and cinnamon bread. R1 stated the staff made sure he was getting the right food but a lot of times was given the wrong food. ADM confirmed R1 is on diabetic diet and the kitchen staff were aware and that R1 is very particular with his diet. Copy of kitchen list showed R1 is diabetic and listed food that R1 dislikes. S1 stated the kitchen staff knew residents who were on diabetic diet. S1 also stated that residents shared food with each other, but when S1 sees resident is given the food that the resident should not have, she takes it away. Therefore, the allegation is unsubstantiated.

.......continued on 9099C

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20260105105331

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: BETHESDA HOME	FACILITY NUMBER: 011400061
	VISIT DATE: 01/06/2026

NARRATIVE

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Allegation: Staff did not safeguard resident's personal belongings.
RP reported that R1's son purchased glucose sensors and that R1 thinks the staff were using them on other residents because they would say the sensors ran out. R1 stated he was told the sensors ran out and the staff has to do manual pricking to test his glucose level. S1 and ADM stated it's only R1 who uses glucose sensor. S1 and ADM also stated there were times when sensors were faulty and they have to do manual testing. ADM stated that on the last shipment of the sensors to the facility on December 2025, the delivery was late. ADM added that the sensor can not be use by others because the code has to be entered on sensor and the sensor sends the readings to R1's doctor so if there's multiple people using R1's sensor, the doctor will receive multiple readings of which the doctor will be alerted why he's receiving multiple readings. Therefore, the allegation is unsubstantiated.

Based on information gathered, all 5 allegations were unsubstantiated. A finding that a complaint is unsubstantiated means that means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiency cited.

Exit interview conducted and copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC9099 (FAS) - (06/04)

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