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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201495
Report Date: 12/30/2025
Date Signed: 12/30/2025 04:19:29 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
09/24/2025 and conducted by Evaluator Patricia Manalo
COMPLAINT CONTROL NUMBER: 15-AS-20250924164021
FACILITY NAME:LINCOLN VILLAFACILITY NUMBER:
019201495
ADMINISTRATOR:DIVINA FERNANDEZFACILITY TYPE:
740
ADDRESS:41040 LINCOLN STREETTELEPHONE:
(510) 656-4373
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:80CENSUS: 78DATE:
12/30/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Divina Fernandez TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not prevent a resident from developing scabies while in care.
INVESTIGATION FINDINGS:
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On 12/30/2025 at 1:50 PM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct more interviews and deliver findings on the above allegation. LPA met with Administrator, Divina Fernandez, and explained the purpose of the visit.

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

LPA obtained the following documents including but not limited to LIC500, Resident Roster, Fax Documentation to Physicians, Doctor’s Order for Medication, Local Public Health (LPH) documentation of the outbreak, After Visit Summaries, SOC341, Staff Contact Information and Shower and Sheet Log.

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

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
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 5
Control Number 15-AS-20250924164021
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: LINCOLN VILLA
FACILITY NUMBER: 019201495
VISIT DATE: 12/30/2025
NARRATIVE
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Continue from LIC9099…

It was alleged that Staff did not prevent a resident from developing scabies while in care.

On 09/29/2025, the Administrator contacted LPA P. Manalo that the facility has an outbreak of scabies and the first case occurred on 09/24/2025. A review of the Unusual Incident/ Injury Report (LIC624) dated from 09/24/2025 to 09/27/2025 showed that 5 residents had symptoms of itching and discomfort.

On 10/02/2025, LPAs P.Manalo and K. Nguyen conducted a visit and observed staff members wearing Personal Protective Equipment (PPE) before going inside a resident's room.

On 11/03/2025, LPA received an incident report indicated that another resident was also confirmed with scabies. Interview with S5, S8, S9, and S10 verified that there were multiple residents that had rashes. Interview with S5 revealed that the rashes began in October, but management dismissed the reports from S5. Furthermore, S5 stated there were staff members also experiencing rashes.

Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D.

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

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
09/24/2025 and conducted by Evaluator Patricia Manalo
COMPLAINT CONTROL NUMBER: 15-AS-20250924164021

FACILITY NAME:LINCOLN VILLAFACILITY NUMBER:
019201495
ADMINISTRATOR:DIVINA FERNANDEZFACILITY TYPE:
740
ADDRESS:41040 LINCOLN STREETTELEPHONE:
(510) 656-4373
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:80CENSUS: 78DATE:
12/30/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Divina Fernandez TIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
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Staff did not ensure that resident's room is cleaned.
Staff did not clean resident's bedding.
INVESTIGATION FINDINGS:
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On 12/30/2025 at 1:50 PM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct interviews and deliver findings on the above allegations. LPA met with Administrator Divina Fernandez and explained the purpose of the visit.

During the course of investigation, LPAs interviewed staff, witnesses, and residents. LPAs obtained the following documents including but not limited to LIC500, Resident Roster, Fax Documentation to Physicians, Doctor’s Order for Medication, Local Public Health (LPH) documentation of the outbreak, After Visit Summaries, SOC341, Staff Contact information, and Shower and Sheet Log.

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

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20250924164021
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: LINCOLN VILLA
FACILITY NUMBER: 019201495
VISIT DATE: 12/30/2025
NARRATIVE
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Continue from LIC9099…

It was alleged that staff did not ensure that resident’s room is cleaned.

Interview with S3, S5, S8, and S9 confirmed that the residents’ rooms are cleaned every day. S3 stated that S3 will clean and mop around the facility including the residents’ room. Interview with S3 and S5 revealed the two housekeepers are responsible for cleaning the resident’s room on their designated side during their shift. S5 stated that every day, the housekeeper will have a list of rooms to clean. If a room becomes soiled during the day, the housekeeper will add that room to their list to clean. S8 confirmed that there are two staff members that are assigned to clean the rooms every day. S8 stated that if the residents request to have their room cleaned, the assigned staff will clean the room.

Interview with 3 of 4 residents all stated that their rooms will get cleaned every day. Interview with R1, R3, and R4 indicated that there are no issues with their room not being cleaned.

Staff did not clean resident's bedding.

S5 and S8 confirmed that each resident have shower days twice a week. During scheduled shower days, residents beddings will be changed. S8 stated that there are some residents that might need their bedding changed more often and staff will change it according to the residents’ needs. S8 included that if a resident notifies staff that their bedding needs to be changed, staff will change it per resident’s request. Both interviews with S8 and S9 added that if a resident refuses a shower during their shower days, staff will still change the resident’s beddings. S9 indicated that if S9 notices a residents’ bedding has been soiled, S9 will change or clean the bedding right away during their shift.

On 12/30/2025, LPA observed that residents' room and beddings were clean and unsoiled.

Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

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

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20250924164021
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: LINCOLN VILLA
FACILITY NUMBER: 019201495
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/09/2026
Section Cited
CCR
87470(a)(2)
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87470(a)(2) Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows:

This requirement is not met as evidenced by:
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The Administrator agrees to have an in-service with staff regarding infection control plan and how to mitigate the infection. Proof of correction will be sent to CCLD by POC date.
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The licensee did not comply with the section cited above by not preventing a scabies outbreak at the facility which poses an immediate health and safety risk to residents 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: 12/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5