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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075600757
Report Date: 08/14/2025
Date Signed: 09/09/2025 10:27:02 AM

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
04/14/2025 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250414163708
FACILITY NAME:FAMILY COURTYARDFACILITY NUMBER:
075600757
ADMINISTRATOR:TEJERO, NORMAFACILITY TYPE:
740
ADDRESS:2840 SALESIAN AVENUETELEPHONE:
(510) 235-8284
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY:70CENSUS: 44DATE:
08/14/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Norma Tejero, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Staff didn't keep facility free from insects and rodents
Insufficient staffing
INVESTIGATION FINDINGS:
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On 09/09/2025 around 10:00 AM, Licensing Program Analyst (LPA) L. Holmes amended report to add a citation that was not included on 08/14/25; see case management visit dated 09/09/2025.
On 08/14/2025 around 01:00 PM Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver the complaint findings for the investigation. LPA met with Norma Tejero, Administrator

During the investigation, LPA toured the facility, interviewed Staff and Residents, and requested the following documents: Staff Schedule, Resident Roster, Pest Report, and Maintenance receipts/reports for facility repairs. ID/Emergency Contact information, LIC 602, and appraisal needs and services for Clients (C1, C2, C3).

Allegations: SUBSTANTIATED
Continued in 9099C...

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025
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-20250414163708
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: FAMILY COURTYARD
FACILITY NUMBER: 075600757
VISIT DATE: 08/14/2025
NARRATIVE
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...continued from LIC9099

Staff didn't keep facility free from insects and rodents:
The allegation was related to R1. LPA inspected R1’s room and observed clothing items, shoes, linen in place on the bed, books, papers and person items cluttered but organized. LPA did not observe any insects or vermin during the inspection; however, the pest control report from Advanced IPM dated March and Aprl revealed that the kitchen drains, clogged sink in break room, and water heater room were unsanitary that could attract flies, roaches, and other pests. The doors upstairs including the entrance and kitchen, and downstairs doors have gaps, and room #16 has a hole that rodents can fit through.

Insufficient staffing:
W1 stated that there was not any staff present when W1 and his/her colleague arrived at the facility to provide services to R1; W1's colleague had to seek out the care staff. LPA reviewed the staff schedules for April and March 2025. Although the day schedule appeared sufficient, the schedule for nights and graveyard had either one care staff or no one scheduled for graveyard, and no one noted as scheduled to be On-Call per the regulation.

An immediate civil penalty of $250 is hereby assessed for the day of 8/14/2025 listed on LIC421FC.

Based on LPA’s interviews and records reviewed, the preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED. Deficiencies are cited from Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections by plan of correction due date, and any repeat violations within a 12-month period may result in civil penalties.

Exit interview conducted, appeal rights and a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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
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
04/14/2025 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250414163708

FACILITY NAME:FAMILY COURTYARDFACILITY NUMBER:
075600757
ADMINISTRATOR:TEJERO, NORMAFACILITY TYPE:
740
ADDRESS:2840 SALESIAN AVENUETELEPHONE:
(510) 235-8284
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY:70CENSUS: 44DATE:
08/14/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Norma Tejero, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
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8
9
Facility not meeting residents hygiene needs
INVESTIGATION FINDINGS:
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On 08/14/2025 around 01:00 PM Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver the complaint findings for the investigation. LPA met with Norma Tejero, Administrator

During the incetigation, LPA toured the facility, interviewed Staff and Residents, and requested the following documents: Staff Schedule, Resident Roster, Pest Report, and Maintenance receipts/reports for facility repairs. ID/Emergency Contact informaion, LIC 602, and appraisal needs and services for Clients (C1, C2, C3).

Allegations: UNSUBSTANTIATED
Continued in 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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-20250414163708
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: FAMILY COURTYARD
FACILITY NUMBER: 075600757
VISIT DATE: 08/14/2025
NARRATIVE
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... continued from LIC9099A

Facility not meeting residents hygiene needs:


The allegation was reported by W1 and is directly related to R1. R1 needs moderate assistance when using a shower chair, does not have any diagnoses of Dementia or need for bed care; R1 is able to leave the facility unassisted, and can care for his/her own toileting. R2's care log dated April - March 2025 recorded refusals for showers, and when R2 was able to manage their own incontinence.

Based on LPA’s interviews, observations, and records reviewed, the allegation is UNSUBSTANTIATED. The finding that the complaint is unsubstantiated means that the allegation is not valid because the preponderance of the evidence standard has not been met.

Exit interview conducted, and a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20250414163708
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: FAMILY COURTYARD
FACILITY NUMBER: 075600757
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2025
Section Cited
HSC
87303
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87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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Licensee/ADM agreed to in-service staff, and submit a plan with correction dates that will mitigate the spread of insects and vermin to CCLD by POC date.
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Based on records reviewed, Licensee did maintain clean, safe and sanitary conditions which poses/posed a potential 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: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5