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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200923
Report Date: 03/25/2026
Date Signed: 03/25/2026 04:51:10 PM

Substantiated


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
03/19/2026 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20260319142321
FACILITY NAME:ELLE'S HOMEFACILITY NUMBER:
019200923
ADMINISTRATOR:ROCERO, MARIA CARMELAFACILITY TYPE:
740
ADDRESS:2420 COLUMBINE COURTTELEPHONE:
(510) 470-3681
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY:6CENSUS: 6DATE:
03/25/2026
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Maria Carmela 'Marla' Rocero/AdministratorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff is not physically capable of performing tasks which poses a risk to residents in care.
INVESTIGATION FINDINGS:
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On this day, March 25, 2026, at 11:20 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegation. LPA met with Maria Carmela 'Marla' Rocero, administrator (ADM), and informed the reason for visit.

Reporting party (RP) stated the when RP visited, there was only one caregiver present on-site. The caregiver was noted that she ambulates with a slow, shuffling gait, which raises concern regarding the ability to respond promptly in the event of a resident emergency. RP also expressed concern if this caregiver would be physically capable of reaching a resident in a timely manner should a fall occur or emergency assistance be required.

.....continued on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
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-20260319142321
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: ELLE'S HOME
FACILITY NUMBER: 019200923
VISIT DATE: 03/25/2026
NARRATIVE
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During investigation, LPA conducted interviews, made observation and reviewed residents records. Records showed all 6 residents need assistance with most ADLs and 1 resident (R1) needs assistance in transferring.

Although staff (S1) stated she will able to assist the residents in the event of emergency, LPA observed S1 ambulates with a slow, shuffling gait. LPA further observed S1 with shuffling gait when S1 brought the residents in their wheelchair to the dining room. S1 stated she's not able to assist resident (R1) in transferring and provides R1 meals in the bedroom and that it is the administrator (ADM) who transfers R1 from bed to wheelchair. The other staff (S2) also stated giving R1 meals in the bedroom. S2 stated working in the facility on days the ADM is off.

ADM confirmed S1 and S2's statements that she is the one who assists R1 and that she's off on Thursdays and Saturdays.

Based on interviews and records review, the preponderance of evidence is met, therefore, the allegation is substantiated.

Deficiency is cited on Title 22 California Code of Regulations and listed on 9099D. Failure to submit proof of correction by plan of correction due date may result in civil penalty.

Deficiency and plan and proof of correction were discussed with ADM.

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20260319142321
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: ELLE'S HOME
FACILITY NUMBER: 019200923
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2026
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General: (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...... The licensing agency may require any facility to provide additional staff
whenever it determines through.......
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Administrator stated she'll adjust her time and come to the facility early and that addtional staff will cover during her days off.
In addition, administrator to update the LIC500 and submit copy along with staff's job duties/responsibilities by 4/08/26.
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..... such additional staff for the provision of adequate services.
-This requirement is not met as evidenced by:
-Based on records review and interviews, the licensee did not comply with the section above in S1's capabilty to provide assistance to resident.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3