019200761-3-16-2026-15-AS-BFOG-DSXMLX-20260408094305

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200761
Report Date: 03/16/2026
Date Signed: 03/16/2026 03:39:08 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
12/09/2025 and conducted by Evaluator Patricia Manalo

COMPLAINT CONTROL NUMBER: 15-AS-20251209152603

FACILITY NAME:	FREMONT HILLS		FACILITY NUMBER:	019200761
ADMINISTRATOR:	KUMAR, BEENA		FACILITY TYPE:	740
ADDRESS:	35490 MISSION BLVD		TELEPHONE:	(510) 796-4200
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	140	CENSUS: 97	DATE:	03/16/2026
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Mimi Co, Business Office Director		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff did not attend to residents' care needs in a timely manner

INVESTIGATION FINDINGS:

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On 03/16/2026 at 1:35 PM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to deliver the findings on the above allegation. LPA met with Business Office Director, Mimi Co, and explained the purpose of the visit. Executive Director, Beena Kumar, was not available during this time.

During the course of investigation, LPA interviewed staff, residents, and witnesses.

LPA obtained and reviewed documents including but not limited to Personnel Report (LIC500), Resident Roster, Staff Schedule, Staff Contact Information, Facility’s Resident Alert Call System, Facility Call Button Log, physician report, Identification and Emergency Information, service plan, resident move in record, and physician communication fax log.

Continue to LIC9099-C…

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026

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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Control Number 15-AS-20251209152603

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: 03/16/2026

NARRATIVE

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Continued from LIC9099…

Allegation: Staff did not attend to residents' care needs in a timely manner

It was alleged that Staff did not attend to residents' care needs in a timely manner.

Based on interviews conducted, 6 of 7 residents stated that they have call buttons that they can use if they need staff assistance and have no issues during the daytime with staff responding. Interview with R1 indicated that when R1 uses the call button, staff will take approximately 5-7 minutes to respond. Additionally, interviews with 7 of 8 staff members all revealed that residents may use their pendant for assistance and it will notify the staff through their radio. 7 of 8 staff members stated that the average time to respond to the residents’ call could vary between 5 minutes to 20 minutes. S3, S4, and S6 indicated that when they are busy helping a resident and another resident requests for assistance, other staff members can assist with that request.

Interview with W1 revealed that W1 had no issues with the call button when R8 was living in the facility and W2 stated that in the past R4 had issues with the call button response time, however, the issues has been resolved since then.

A review of the facility call log report dated 12/04/2025 showed that R1 used the pendant and waited approximately 4 minutes for staff to respond to R1’s call. All the other dates pertaining to R1’s calls had a response time of less than 2 minutes from the dates 12/08/2025 to 12/19/2025.

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.

There is no deficiency noted.

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: 03/16/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026

LIC9099 (FAS) - (06/04)

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