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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015601280
Report Date: 08/20/2025
Date Signed: 08/20/2025 04:43:00 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
08/14/2025 and conducted by Evaluator Patricia Manalo
COMPLAINT CONTROL NUMBER: 15-AS-20250814161635
FACILITY NAME:FREMONT VILLAGEFACILITY NUMBER:
015601280
ADMINISTRATOR:GINA A VELAYOFACILITY TYPE:
740
ADDRESS:38801 HASTINGS STREETTELEPHONE:
(510) 792-5411
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:120CENSUS: 61DATE:
08/20/2025
UNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Gina Velayo, Administrator TIME COMPLETED:
03:55 PM
ALLEGATION(S):
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Staff prohibit resident visitation
INVESTIGATION FINDINGS:
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On 08/20/2025 at 12:05 PM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct a complaint investigation and deliver findings on the above allegation. LPA met with Administrator, Gina Velayo, and explained the purpose of the visit.

During the course of investigation, LPA interviewed the Administrator (ADM), eight (8) staff members, three (3) witnesses, and family member (FM1). LPA reviewed and obtained documents including but not limited to residents’ Admission Agreement, Resident Information Sheet, Identification and Emergency Information, Resident Roster, Staff Roster, Facility’s Memory Care Visitation Policy, and Facility’s Isolation Policy dated 04/09/2024.

Continue to LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
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 2
Control Number 15-AS-20250814161635
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: FREMONT VILLAGE
FACILITY NUMBER: 015601280
VISIT DATE: 08/20/2025
NARRATIVE
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Continue from LIC9099...

It was alleged that staff prohibit resident visitation. Interview with all the staff and ADM indicated that residents’ families can schedule an appointment to reserve a private room for visitation ahead of time, but family members are able to visit any time during visiting hours. It was also indicated that family members can utilize the visitation room, the courtyard, the dining room in the assisted living area, or the resident’s room if they have a private room or if the resident’s roommate was not there. Interview with Witness 1 (W1) and Witness 2 (W2) stated that they have no issues when it comes to visiting residents at the facility. Interview with Witness 3 (W3) and Family Member 1 (FM1) confirmed that they needed to call ahead and arrange a visit, but they were able to visit Resident 1 (R1) in the visitation room.

Based on interviews and observations conducted, the above allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

There is no deficiency noted.

Exit interview was conducted with Administrator, and a copy of this report was provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2