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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200689
Report Date: 06/27/2025
Date Signed: 06/27/2025 03:15:34 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
06/26/2025 and conducted by Evaluator Ardalan Gharachorloo
COMPLAINT CONTROL NUMBER: 15-AS-20250626110145
FACILITY NAME:WOODSIDE RESIDENTIAL CARE FACILITY FOR ELDERLYFACILITY NUMBER:
019200689
ADMINISTRATOR:MIRRIAM PARASFACILITY TYPE:
740
ADDRESS:20531 FOREST AVENUETELEPHONE:
(510) 397-0335
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY:14CENSUS: 13DATE:
06/27/2025
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Mirriam Paras, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did not safeguard resident's cash resources.
INVESTIGATION FINDINGS:
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On 06/27/2025 at 1:45 PM, Licensing Program Analyst (LPAs) Ardalan Gharachorloo and Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegation above. LPAs met Mirriam Paras, Administrator, and explained the purpose of the visit.

During the course of the investigation, LPAs reviewed R1s physician's report dated 03/25/2024. R1 has a diagnosis of dementia. LPAs also interviewed S1 and W1 and toured R1's bedroom.

W1 reported that R1 brought $4242 in cash to a to his day program where the funds were counted and sealed in an envelope. Upon R1's return to the facility, R1appeared confused and dropped the envelop and staff helped R1 recover the contents. W1 later discovered that $1500 was missing from the original amount and stated that the facility administrator and staff were notified. S1 added that R1 had a stroke shortly thereafter and was transferred to Hayward Hills Rehab.

***CONTINUE ON 9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025
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-20250626110145
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: WOODSIDE RESIDENTIAL CARE FACILITY FOR ELDERLY
FACILITY NUMBER: 019200689
VISIT DATE: 06/27/2025
NARRATIVE
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***CONTINUE FROM 9099***

In an interview with S1, S1 confirmed that the day program placed the money in an envelope and put the envelop in a bag attached to R1's wheelchair. S1 stated the resident was at the facility for approximately two hours and appeared weak and staff called 911. While R1 was at the facility, staff assisted him in putting all the money they found in his room back in the envelope. S1 has offered to reimburse W1 the amount of money W1 feels is missing from the envelope. S1 further stated that she has no idea where R1 is getting this amount of cash. R1 is currently in the rehab program.

This agency has investigated the complaint alleging staff did not safeguard resident's cash resources. 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: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2