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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201063
Report Date: 10/29/2025
Date Signed: 10/29/2025 01:44:23 PM

Substantiated


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
10/23/2025 and conducted by Evaluator Patricia Manalo
COMPLAINT CONTROL NUMBER: 15-AS-20251023135316
FACILITY NAME:AEGIS GARDENSFACILITY NUMBER:
019201063
ADMINISTRATOR:POON, EMILYFACILITY TYPE:
740
ADDRESS:36281 FREMONT BLVDTELEPHONE:
(510) 739-0909
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:85CENSUS: 71DATE:
10/29/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Angel Lee, Director of Operations TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff obstructed the facility passageway
INVESTIGATION FINDINGS:
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On 10/29/2025 at 9:35 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct a complaint investigation and deliver the findings on the above allegation. LPA met with the Director of Operations, Angel Lee, and explained the purpose of the visit. Executive Director (ED), Emily Poon, was unavailable during today’s visit.

During the course of investigation, LPA interviewed 4 staff, witness, and toured the memory care unit.

LPA reviewed and obtained documents including but not limited to Incident Report, Resident Roster, Staff Roster, and Staff Schedule.

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

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
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-20251023135316
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: AEGIS GARDENS
FACILITY NUMBER: 019201063
VISIT DATE: 10/29/2025
NARRATIVE
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Continue from LIC9099...

It was alleged that staff obstructed the facility passageway. During the visit, LPA observed the memory care hallway by the exit door free of obstruction. However, on 10/24/2025, LPA received an incident report from ED verifying that on 10/15/2025 and 10/22/2025, there were chairs blocking the side exit door in memory care to prevent the ball from getting into the hallway. During the visit, interviews with 4 of 4 staff confirmed that the chairs were utilized to block the exit door during games and activities with residents. 4 of 4 staff members also showed LPA where the three chairs would be placed during activities in which LPA observed to be in the hallway in front of the side exit door.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D.

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

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20251023135316
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: AEGIS GARDENS
FACILITY NUMBER: 019201063
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/07/2025
Section Cited
CCR
87307(d)(6)
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87307(d)(6) Personal Accommodations and Services (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.

This requirement is not met as evidenced by:
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The Administrator agrees to have an in-service training with all staff, create alternative plan for conducting activies in memory care, and send proof to CCLD by POC date.
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Based on interviews and record review, the licensee did not comply with the section cited above by having chairs blocking the side exit door in the memory care unit which posed a potential safety risk to persons in care.
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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: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3