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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200673
Report Date: 01/22/2025
Date Signed: 01/22/2025 03:38:59 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
01/13/2025 and conducted by Evaluator Gregory Clark
COMPLAINT CONTROL NUMBER: 15-AS-20250113161430
FACILITY NAME:D'NALOR CARE HOMES, LLCFACILITY NUMBER:
019200673
ADMINISTRATOR:WILSON, ROLANDFACILITY TYPE:
740
ADDRESS:2706 106TH AVETELEPHONE:
(510) 756-6122
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:6CENSUS: 6DATE:
01/22/2025
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Roland Wilson, AdministratorTIME COMPLETED:
03:55 PM
ALLEGATION(S):
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Resident was given an insulin injection by staff who is not an appropriately skilled professional
INVESTIGATION FINDINGS:
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On 1/22/25 at 2:45 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct a 10 day complaint investigation and deliver findings in regard to the allegation above. LPA met with Roland Wilson, Administrator and explained the purpose of the visit.

During the course of the investigation LPA interviewed facility resident (R1) and facility staff (S1 and S2) and reviewed R1's file and facility schedule for January 2025.

R1's physician’s report documented that R1 is capable of administering her own insulin. LPA interviewed R1 who stated that she administers her insulin mostly “on my own.” Staff adjust the dosage but do not assist with the injection itself.

Facility staff also stated that R1 administers her insulin by herself and that they never touch her needles. Staff also stated that they make sure that R1 disposes of her needles properlyin the sharp disposal container in the kitchen.

***report continujes on LIC9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
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-20250113161430
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: D'NALOR CARE HOMES, LLC
FACILITY NUMBER: 019200673
VISIT DATE: 01/22/2025
NARRATIVE
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***report continues from LIC9099***

LPA also reviewed the staff schedule for Saturday 1/11/25 to confirm staff on duty and S1 and S2 were the staff on duty.

This agency has investigated the complaint alleging resident was given an insulin injection by staff who is not an appropriately skilled professional. We have found that the complaint was 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.

Exit interview conducted, a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2