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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601016
Report Date: 07/01/2025
Date Signed: 07/01/2025 10:53:31 AM

Unsubstantiated


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
04/30/2025 and conducted by Evaluator Laura Hall
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250430100438
FACILITY NAME:SIVILAY ELDERLY HOME CAREFACILITY NUMBER:
075601016
ADMINISTRATOR:LAINE, RACHAELFACILITY TYPE:
740
ADDRESS:2242 MT. WHITNEY DRIVETELEPHONE:
(925) 709-0956
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:6CENSUS: 6DATE:
07/01/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Brenda Solis, CaregiverTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility staff financially abused resident
INVESTIGATION FINDINGS:
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On 7/1/2025 at 10:10am, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint findings for the allegation above. LPA met with Brenda Solis, Caregiver and explained the reason for the visit. Licensee, Noupane Temple, arrived at 10:35am.

During the course of the investigation the Department conducted interviews with staff, witnesses, resident, obtained and review records.

Allegation: Facility staff financially abused resident.

Based on interview with W1 there was a safe in R1’s bedroom closet with a very large sum of money which belonged to R1. W1 did not know the exact amount but was told an approximation. W1 stated R1 was admitted into the hospital on 4/15/2025 and the safe was retrieved a couple of days later from the facility. W1 stated after having the money counted it appeared the safe was missing over half of the money.

Continued on LIC9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
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 2
Control Number 15-AS-20250430100438
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: SIVILAY ELDERLY HOME CARE
FACILITY NUMBER: 075601016
VISIT DATE: 07/01/2025
NARRATIVE
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Continued from LIC9099.

amount but was told an approximation. W1 stated R1 was admitted into the hospital on 4/15/2025 and the safe was retrieved a couple of days later from the facility. W1 stated after having the money counted it appeared the safe was missing over half of the money. W1 stated the staff was financially abusing R1 by taking or receiving money from R1 during the time R1 resided at the facility. The LPA interviewed S1, S2, and S3. All stated they had no idea there was money in the safe. S2 stated R1 told her there were pictures in there. S2 also stated R1 would not let any one touch his belongings. The LPA tried to interview R1, but due R1’s diagnosis it was difficult to communicate. During interview with W2 LPA was told the exact amount of money in the safe was unknown. W2 did indicate that R1 handled his own finances. W2 stated he told W1 how much he thought was in the safe. W2 stated R1 had requested W2 to retrieve the safe and bring it to the facility soon after he moved into the facility. W2 stated he did not count the money only took pictures on 12/13/2023 (pictures submitted). W2 stated he knew for sure that R1 had used some of the money for rent, bought food, personal items, and had given W2 a certain amount for helping him.

Based upon the information obtained and the interviews conducted during the investigation, the above allegation is 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: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2