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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200761
Report Date: 07/22/2025
Date Signed: 07/22/2025 02:00:58 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
03/25/2025 and conducted by Evaluator Patricia Manalo
COMPLAINT CONTROL NUMBER: 15-AS-20250325125744
FACILITY NAME:FREMONT HILLSFACILITY NUMBER:
019200761
ADMINISTRATOR:VIRAY, BERNADETTE MFACILITY TYPE:
740
ADDRESS:35490 MISSION BLVDTELEPHONE:
(510) 796-4200
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:140CENSUS: 87DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Beena Kumar, Executive Director TIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff does not treat resident with respect and dignity
Staff did not provide assistance to a resident in a timely manner
INVESTIGATION FINDINGS:
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On 07/22/2025 at 12:35 PM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to deliver finding on the above allegations.

During the course of investigation, LPAs P. Manalo and and L. Fontanilla conducted interviews with 5 residents and 5 staff.

LPA P.Manalo obtained the following documents such as the Resident Roster, Staff Schedule, Residents' Service Plan Report, Physician's Report, Rcare Call Volume by Hour Report dated for 03/24/2025 to 03/25/2025, Rcare Incident List Report dated 03/25/2025- 03/26/2025, Hospice Information and facility's Resident Alert Call System policy.

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

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
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 3
Control Number 15-AS-20250325125744
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 HILLS
FACILITY NUMBER: 019200761
VISIT DATE: 07/22/2025
NARRATIVE
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Continue from LIC9099...

Allegation- Staff does not treat resident with respect and dignity.

It was alleged that Staff 3 (S3) yelled at R1 when asked for assistance and that S3 would leave R1’s diaper in the trash can beside R1’s bed without lining the basket with a trash bag. 4 out of 5 residents interviewed stated that the staff are nice and that they receive good care at the facility. R5 stated that when they call for help at night, R5 can fall asleep after receiving care. Interview with S2 indicated that it’s rare for S2 to observe wet diapers in the beginning of their shift on the resident and in the resident’s room, however, it could be a possibility that staff would forget to pick it up. LPA attempted to interview S3 and S4 and did not receive any call back. 3 out of 5 staff members interviewed expressed that they have not heard any other
staff members speak to residents rudely.

Allegation: Staff did not provide assistance to a resident in a timely manner.

Based on interviews conducted with residents, each resident is provided with a call button or pendant that can be utilized to call staff, if needed. R1 stated that when R1 needed assistance at night, S3 and S4 took a long time to arrive to R1’s room for assistance. S1 also stated that during night shifts, the staff are supposed to attend to resident’s calls together. Interview with R5 indicated that when R5 needs assistance at night, R5 will use the call button and have not experienced any issues with the care at night. Also, 4 out of 5 residents interviewed stated that staff will assist them when needed.

Staff interviewed revealed that when residents need assistance, staff will receive a radio call from which resident and room needs to be tended to. If a staff member was unable to attend the call, they will reach out to another staff member that is available to respond to the resident.

Continue to LIC9099-C...
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20250325125744
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 HILLS
FACILITY NUMBER: 019200761
VISIT DATE: 07/22/2025
NARRATIVE
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Continue from LIC9099-C...

A review of the facility’s call log dated 03/25/2025 during the night shift between 1:00 AM to 4:30 AM showed that the response time varied from three seconds to about three and a half hours. S1 stated that during this time the system was having computer issues and could not clear the calls. Staff were able to reset the system at around 5:30 AM on 03/25/2025. After the computer issues were resolved, the response time for when residents would call for assistance varied from seconds to about twelve minutes that night. Although a review of the facility’s Resident Alert Call System policy dated 06/01/2025 does not indicate a response time, interviews with S6 and S7 revealed that staff will attempt to respond within 10 to 15 minutes of a residents’ call.

There is no deficiency noted.

Based on interviews and record reviews 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 violation did or did not occur, therefore the allegation is unsubstantiated.

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

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
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