<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601216
Report Date: 08/07/2025
Date Signed: 08/07/2025 01:58:26 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
06/19/2024 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20240619090132
FACILITY NAME:ABEL CARE HOMEFACILITY NUMBER:
075601216
ADMINISTRATOR:MATIAS, JERRYFACILITY TYPE:
740
ADDRESS:899 PLA VADA COURTTELEPHONE:
(925) 798-0550
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:6CENSUS: 4DATE:
08/07/2025
UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Lailo Matias, LicenseeTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not adequately trained
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/07/2025 at 1:25 PM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to deliver findings for the above allegations. LPA explained the purpose of the visit with Administrator Lailo Matias.

On the allegation: Staff are not adequately trained.
Based on interviews, staff never received any training regarding pressure injuries. In an interview it was stated that staff did not have any training regarding pressure injuries and, did not feel comfortable providing care to R1’s pressure injuries without that training.

Based on LPA’s interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The California Code of Regulations, Title 22 has been cited. Exit interview conducted. A copy appeal rights, and this report provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
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 4
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
06/19/2024 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20240619090132

FACILITY NAME:ABEL CARE HOMEFACILITY NUMBER:
075601216
ADMINISTRATOR:MATIAS, JERRYFACILITY TYPE:
740
ADDRESS:899 PLA VADA COURTTELEPHONE:
(925) 798-0550
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:6CENSUS: 4DATE:
08/07/2025
UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Lailo Matias, LicenseeTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Due to staff negligence, residents developed multiple pressure injuries while in care
Staff did not seek medical attention for residents in a timely manner
Staff are not following residents’ special diet
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/07/2025 at 1:45 PM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to deliver findings for the above allegations. LPA explained the purpose of the visit with Administrator Lailo Matias.
During the course of the investigation, The Department conducted interviews with staff, residents, witnesses, and complainant. Resident’s physician’s report, care plan, care notes, photos, incident reports, medical records, and hospital discharge records were obtained and reviewed.

On the allegation: Due to staff negligence, residents developed multiple pressure injuries while in care. R1 already had a pressure injury on his sacrum when he moved into the home in August of 2023.Home Health nurses visited R1 at the facility and treated his pressure injuries two to three times per week. According to the home health nurses, R1 received appropriate care from the facility staff to prevent R1’ pressure injury from getting worse.
Continued on Lic9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20240619090132
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: ABEL CARE HOME
FACILITY NUMBER: 075601216
VISIT DATE: 08/07/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
...Continued from Lic 9099-A

Hospital discharge planners, doctors, home health nurses all suggested that R1 should be placed on hospice care due to his condition and requiring a higher level of care; and W1 was told by S1 and JMH home health nurses that the facility would not be able to retain R1 if his pressure injuries went beyond stage two per licensing regulations.

On the allegation: Staff did not seek medical attention for residents in a timely manner. Based on interviews, on 3/15/24 R1 started having trouble breathing so W1 asked S3 to call 911. As the phone call was happening the phone was passed over to W1 at their request.

On the allegation: Staff are not following residents’ special diet. Based on interviews, R1 was on a special diet of pureed foods and thickened liquids. R1’s physicians report and medical records state that R1 needed pureed foods that were honey thick, and R1 needed to sit up after meals at or above 45 degrees due to high risk for aspiration. Staff interviewed stated that they thought that W1 did not trust staff to feed him properly so W1 brought R1’s food to the facility to prepare it for him and fed him.

Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 15-AS-20240619090132
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: ABEL CARE HOME
FACILITY NUMBER: 075601216
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2025
Section Cited
CCR
87411(c)
1
2
3
4
5
6
7
87411 (c) All RCFE staff who assist residents with daily activities shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69

1
2
3
4
5
6
7
By POC date, the Administrator states that all care staff will get trained on the following topics;pressure sore prevention, wound care, firt aid training and personal rights. Licensee will submit a sign in log for the training or individual certificates of completion to CCLD by POC date.
8
9
10
11
12
13
14
Based on records review and interviews, the licensee did not comply with the section cited above by having staff preform wound care without the associated training which posed an potential health and safety risk to the residents
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4