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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200702
Report Date: 09/03/2025
Date Signed: 09/03/2025 01:47:31 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
08/26/2025 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20250826153953
FACILITY NAME:HARMONY HOMES LLCFACILITY NUMBER:
019200702
ADMINISTRATOR:NATH, NALINIFACILITY TYPE:
740
ADDRESS:3263 SANTA CLARA COURTTELEPHONE:
(510) 400-9373
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:6CENSUS: 4DATE:
09/03/2025
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Nalini Nath, Administrator TIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are using a restraint on a resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On September 3, 2025, at approximately 9:25 a.m., LPAs K. Nguyen and P. Manalo arrived to conduct an unannounced complaint investigation. LPAs met with Administrator (ADM) Nalini Nath, explaining the purpose of their visit.

It was allegeded that Staff are using a restraint on a resident. LPAs investigated with the Reporting Party (RP). On the same day, LPAs initiated an initial investigation, obtained records for Resident 1 (R1), and interviewed the hospice nurse, Administrator, and two caregivers. Based on an interview with a hospice nurse and a recorded review, it shows that R1 has a doctor's order for a soft belt to prevent R1 from falling out of the wheelchair. LPAs verified the order from R1's hospice binder, including, but not limited to, LIC 602.

Based on interviews conducted and records reviewed, the above allegation is unsubstantiated. The preponderance of evidence standard has not been met; therefore, the above allegation is found to be unsubstantiated.

An exit interview is conducted and a copy of this report is provided.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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