<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015601483
Report Date: 01/21/2026
Date Signed: 01/21/2026 04:40:17 PM

Substantiated


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
01/14/2026 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20260114102414
FACILITY NAME:ST. LOURDES HOMEFACILITY NUMBER:
015601483
ADMINISTRATOR:BALINTONA, JUSTINOFACILITY TYPE:
740
ADDRESS:1626 ASHBURY LANETELEPHONE:
(510) 265-0818
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY:6CENSUS: 6DATE:
01/21/2026
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Norma Gano/StaffTIME COMPLETED:
04:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not allow the Ombudsman representative to conduct a facility visit.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, January 21, 2026, at 2:20 p.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegation. LPA was granted entry by Norma Gano, staff. LPA spoke over the phone with Justino Balintona, licensee/administrator and discussed the allegation.

It was alleged that an Ombudsman (OMB) attempted to conduct a general visit at the facility on January 9, 2026, was greeted by a caregiver who did not let OMB to enter the and was told the owner (licensee) was currently not at the facility. The reporting party also stated that OMB explained that OMB is the ombudsman with the identification (ID) front facing visible but the caregiver still reiterated the same thing.


......continued on 9099C


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
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-20260114102414
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: ST. LOURDES HOME
FACILITY NUMBER: 015601483
VISIT DATE: 01/21/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA interviewed Ombudsman (OMB) on January 15, 2026 and staff (S1, S2) and licensee on this day, January 21, 2026.

OMB confirmed wearing an identification (ID) with inscription 'Empowered Aging' and OMB's picture on it. OMB stated introducing self to the caregiver, was told the licensee was not at the facility and didn't allow OMB entry.

S1 stated OMB came on January 9, 2026. S1 stated she didn't understand what OMB was saying but observed OMB wearing shirt with 'Empowered' print on it. S1 confirmed the licensee was not at the facility at that time and that she did not allow OMB to come in. S2 stated she was the facility when OMB came. S2 at first stated hearing OMB said 'Ombudsman' but later said not hearing it. The licensee confirmed he was not at the facility when OMB arrived and that S1 called him but OMB had left after the conversation with S1.

Based on information gathered, the preponderance of evidence is met, therefore the allegation is substantiated.

Deficiency is cited from Title 22 California Code of Regulations, and listed on 9099D. Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty.

Deficiency and plan and proof of correction were discussed with the licensee over the phone. Licensee authorized Norma Gano to sign and receive this report.

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20260114102414
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: ST. LOURDES HOME
FACILITY NUMBER: 015601483
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/04/2026
Section Cited
HSC
87468.1(a)(11)
1
2
3
4
5
6
7
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
1
2
3
4
5
6
7
Administrator stated he will conduct in-service training. Copy of training topics with attendees signatures to be submitted by 2/04/26.
8
9
10
11
12
13
14
and without prior notice........
-This requirement is not met as evidenced by:
-Based on interviews, the licensee did not comply with the section above in staff not allowing entry to Ombudsman which posed a potential personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3