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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600118
Report Date: 04/20/2026
Date Signed: 04/20/2026 12:17:05 PM

Unsubstantiated


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
04/10/2026 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20260410150300
FACILITY NAME:CARLTON PLAZA OF FREMONTFACILITY NUMBER:
015600118
ADMINISTRATOR:AMARI, GIANNIFACILITY TYPE:
740
ADDRESS:3800 WALNUT AVENUETELEPHONE:
(510) 505-0555
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:128CENSUS: 128DATE:
04/20/2026
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Executive Director, Gianni AmariTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Facility mismanaging residents medications
INVESTIGATION FINDINGS:
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On 4/20/2026 at 8:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct the initial 10-day investigation and deliver findings for the above allegation. LPA met with Executive Director, Gianni Amari and explained the purpose of the visit.

During the course of the investigation, the LPA reviewed R1, R2, R3, and R4's care plans, medication addmission record (MAR), medication log, medication notes, and physicians orders.

Report continues on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
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 2
Control Number 15-AS-20260410150300
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: CARLTON PLAZA OF FREMONT
FACILITY NUMBER: 015600118
VISIT DATE: 04/20/2026
NARRATIVE
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On the allegation "Facility mismanaging residents medications" it was observed that R1-R4 are all on medication assistance and have their medications managed by the facility. A review of the MAR showed that all medications have been administered according to the physicians orders. LPA interviewed the med-tech on duty on how they work with residents who's medications require them to be taken prior to meals. Med-tech stated that they advise those residents to wait in their room for med-techs to give the meds or meet the residents in dining. LPA also observed in the MAR when residents dosages have been changed and it aligned with physicians orders and medications observed in the med cart. LPA was unable to identify a resident who's medications are being mismanaged and that all medications administered are of the proper dosage and proper time 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.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2