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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600812
Report Date: 03/12/2026
Date Signed: 03/12/2026 12:24:02 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
03/09/2026 and conducted by Evaluator Yasamin Brown
COMPLAINT CONTROL NUMBER: 15-AS-20260309124645
FACILITY NAME:ANDRE ALEXIS GUEST HOMEFACILITY NUMBER:
015600812
ADMINISTRATOR:JUNTILLA, ALEX P.FACILITY TYPE:
740
ADDRESS:1617 CHARLES ROADTELEPHONE:
(510) 430-1351
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:6CENSUS: 4DATE:
03/12/2026
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Alex Juntilla, Administrator TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff dd not grant the Ombudsman access into the facility.
INVESTIGATION FINDINGS:
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On 3/12/2026 at 10:45 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with Norma Cabrera, caregiver and informed her the reason for visit. Norma phoned Alex Juntilla, administrator and he arrived to the facility at 11:21 AM.

During the course of investigation, LPA interviewed two (2) staff members and the Administrator.

Continued on LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
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-20260309124645
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: ANDRE ALEXIS GUEST HOME
FACILITY NUMBER: 015600812
VISIT DATE: 03/12/2026
NARRATIVE
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Allegation: Staff did not grant the Ombudsman access into the facility.
Finding: Substantiated

Interview with Administrator revealed that they were made aware that staff did not grant the Ombudsmen into the facility. Interview with staff revealed that on 3/6/2026, S3 did not allow the Ombudsmen access into the facility. S3 stated that they were not aware that they needed to give Ombudsmen access to the facility without telling the administrator first.

Based on LPA information obtained during investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC9099D.

Exit interview was conducted with Alex, appeal rights and a copy of this report was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20260309124645
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: ANDRE ALEXIS GUEST HOME
FACILITY NUMBER: 015600812
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2026
Section Cited
CCR
87468.1(a)(11)
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***This is an amended report from visit on 3/12/2026***
87468.1 Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon.
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***This is an amended report from visit on 3/12/2026***
By POC date, the Administrator agrees to conduct an in-service training with all staff that reviews the regulation 87468.1 and submit sign-in sheet to CCLD.
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Based on observation, the licensee did not comply with the section cited above in that the staff did not grant ombudsmen access to the facility which poses an immediate personal rights risk to persons 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: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3