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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075600757
Report Date: 08/21/2025
Date Signed: 08/21/2025 02:05:30 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
04/08/2025 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250408085517
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: 43DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Norma Tejero, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Facility is not clean and sanitary
A comfortable tempature is not maintained for the residents at the facility
Disinfectants and poisons are not inaccessible to residents
Facility is not providing a weekly menu for residents in care
Facility did not give written notice of a rate increase
Facility toilets are in disrepair
INVESTIGATION FINDINGS:
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On 08/21/2025 around 12:30 PM Licensing Program Analyst (LPA) L. Holmes conducted an unannounced visit to deliver the complaint. LPA presented the allegations to Joseph Taburaza, Licensee and Norma Tejero, Administrator.

During the investigation, LPA toured the facility, interviewed Staff (S1, S2, S3, S4) and Witnesses, Residents, and requested the following documents: Staff Schedule, Resident Roster, Maintenance receipts/reports for facility repairs for March 2025, weekly menu for March & April 2025. Admission Agreement, ID/Emergency Contact informaion, LIC 602, and appraisal needs and services for Residents (R1, R2, R3, R4, R5).

Allegations: SUBSTANTIATED
Continued on 9099C...

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

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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 7
Control Number 15-AS-20250408085517
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: 08/21/2025
NARRATIVE
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32
...continued from LIC9099.

Facility is not clean and sanitary
The pest control report from Advanced IPM dated March and April revealed that the kitchen drains, clogged sink in break room, and water heater room were unsanitary that could attract flies, roaches, and other pests. W1 reported and provided photos from 04/07/25 of a clogged toilet with what appeared to be urine; the bathroom floor had soiled medical chucks with fluids that had run onto the floors and into the crevices. Deficiency cited and civil penalties were issued on 08/14/25.

A comfortable temperature is not maintained for the residents at the facility
LPA, S1 and S3 inspected the thermostat at the facility, and recorded 65 degrees Fahrenheit (F) on the north wing and 66 degrees F on the south wing. S1 presented a portable thermostat that displayed 72.8 degrees F. S1 stated that there were times when the exit doors were left open by the residents and the surge of outside air affected the temperature inside the building and oftentimes the staff constantly reminded the residents, and the residents still forgot to close the doors. Although the temperature regulatory standards both thermostats affixed to the walls were inoperable or unable to be adjusted. Deficiency cited and civil penalties were issued on 08/14/25.

Disinfectants and poisons are not inaccessible to residents
LPA arrived unannounced on 04/08/25, observed a green grocery shopping cart in the hallway near room #11 that was used to transport linens and all-purpose cleaning supplies (what appeared to be a cleaning solution in a Fruit Punch container and Fabulosa). The cart was unattended near room #11. When S4 appeared, LPA asked S4 was she/he housekeeping and S4 replied yes. S1 stated that S4 was cleaning and that he/she had spoken to the staff before about leaving the cleaning items unattended. W1 reported and provided photos from 04/07/25 of disinfectants accessible to residents.

Facility is not providing a weekly menu for residents in care
S1 provided LPA the following written statement, “We do not post an alternative menu, but we do cater to residents’ requests if the served menu is not appropriate to them. The cook gave a list of alternative meals readily available upon request to W1. This list is now posted in the dining room.” LPA requested copies on the weekly menu from S3 and there was not a record kept on file for 30 days.
Continued on LIC9099C...

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

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 15-AS-20250408085517
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: 08/21/2025
NARRATIVE
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...continued from LIC9099C.

Facility did not give written notice of a rate increase
LPA reviewed facility records and Admission Agreements for R1, R2, R3, R4 and R5. Page 4, 8. Rate Change, A. states “The agreement must inform the resident of the conditions under which rates may be increased and provide no less than 60 days prior written notice to the resident’s responsible person.” S1, S3 and W1 confirmed that residents were not given a 60 day notice for rate increases.

Facility toilets are in disrepair


W1 reported and provided photos from 04/07/25 of a clogged toilet with what appeared to be urine; the bathroom floor had soiled medical chucks with fluids that had run onto the floors and into the crevices. S1 stated that the toilet was repaired on 04/07/25. Deficiency cited and civil penalties were issued on 08/14/25.

Based on LPA’s observations, interviews and records reviewed, the preponderance of evidence standard has been met; therefore, the above allegations are 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: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
04/08/2025 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250408085517

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:
08/21/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Norma Tejero, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not providing alternative foods for religious and cultural beliefs
Facility is not assisting residets with incontinence care
Facility does not have appropriate number of showers for residents in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/21/2025 around 12:30 PM Licensing Program Analyst (LPA) L. Holmes conducted an unannounced vist to deliver the complaint. LPA presented the allegations to Joseph Taburaza, Licensee and Norma Tejero, Administrator.

During the investigation, LPA toured the facility, interviewed Staff (S1, S2, S3, S4) and Witnesses, Residents, and requested the following documents: Staff Schedule, Resident Roster, Maintenance receipts/reports for facility repairs for March 2025, weekly menu for March & April 2025. Admission Agreement, ID/Emergency Contact informaion, LIC 602, and appraisal needs and services for Residents (R1, R2, R3, R4, R5).

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

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 15-AS-20250408085517
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: 08/21/2025
NARRATIVE
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...continued from LIC9099A.

Facility is not providing alternative foods for religious and cultural beliefs
On 04/22/25, LPA and S3 toured the kitchen and observed a variety of canned and fresh vegetables, fruits, proteins, juices, milk, and water. LPA reviewed the lunch menu that offered cheese pizza, chili beans, corn, mixed vegetables, pineapple, yogurt, milk, juice and coffee that was appropriate for a variety of cultural and religious backgrounds and food habits of residents.

Facility is not assisting residents with incontinence care


W2 reported that R1’s hygiene needs weren’t being met. 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. R5's care log dated April - March 2025 recorded refusals for showers, and when R5 was able to manage their own incontinence. Records revealed that R2, R3, and R4 can care for their own toileting.

Facility does not have appropriate number of showers for residents in care


Although a toilet was in disrepair, the facility had at least one bathtub or shower for each ten (10) persons that was able to provide personal accommodations and services, which included residents, family and live-in personnel.

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

Exit interview conducted, and a copy of this report provided to Norma Tejero, Administrator.

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

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 15-AS-20250408085517
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: 08/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/21/2025
Section Cited
CCR
87309(a)
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87309 Storage Space and Access(a) ...ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger...are not left unattended if outside the locked storage.
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Licensee/ADM in-serviced staff, and submitted proof of correction to CCLD by POC date.
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Based on observations and interviews, S5 left cleaning solutions unattended which posed an immediate health and safety risk to residents in care.
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Type B
08/28/2025
Section Cited
CCR
87555(b)(6)
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87555 General Food Service Requirements (b) The following food service requirements ...for sixteen (16) persons or more, menus shall be written at least one week in advance and copies of the menus as served shall be dated and kept on file for at least 30 days.-This requirement was not met as evidenced by:
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Licensee/ADM agreed to provide in-service training to staff/cook to post weekly menus, alternative meals & retain copies for a minimum of 30 days. Submit a list of attendees’ signatures as proof to CCLD by POC date.
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Based on observations and interviews, weekly menuswere not posted and kept on file per the regulation 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: 08/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 15-AS-20250408085517
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: 08/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2025
Section Cited
CCR
87507(g)(4)
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87507 Admission Agreements (g)... shall specify the following: (4) Modification conditions...at least 60 days prior written notice to the resident of any rate or rate structure change, or as soon as the licensee is notified of SSI/SSP rate changes.-This requirement was not met as evidenced by:

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Licensee/ADM agreed to submit a template for rate increases to CCLD by POC date.
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Based on records reviewed and interviews, Licensee/ADM did not provide residences proper notice of rate increases per the regulations.
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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: 08/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7