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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601216
Report Date: 11/07/2025
Date Signed: 11/07/2025 12:14:09 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
07/17/2025 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20250717104148
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:
11/07/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Lailo Matias, LicenseeTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff are not providing adequate food service to residents
Staff screams at residents
INVESTIGATION FINDINGS:
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On 11/07/2025 at 11:00 AM, Licensing Program Analysts (LPA), J. Clancy-Czuleger arrived unannounced to deliver complaint findings for the above allegations. LPA met with Lailo Matias, Administrator and explained the reason for the visit.

During the course of the investigation, LPA obtained information, reviewed records, collected documents and interviewed staff and residents. It was alleged staff member physically abused resident by punching R1 in the arms and shoulders. However, based on interview staff denied hitting or pushing R1 nor observed staff hitting or pushing other clients.

On the allegation: Staff are not providing adequate food service to residents
LPA observed empty fruit basket with two brown bananas, a lime and a single clementine. The cabinets were half empty with cans pushed forward to block the empty shelf behind. There were about a half dozen potatoes that were starting to sprout freezer was bare, with three boxes of frozen popsicles and a tub of ice cream.
Continued on 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
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 5
Control Number 15-AS-20250717104148
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: 11/07/2025
NARRATIVE
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... Continued from 9099

Fridge had multiple packs of hot-dogs, three bags of bread and some fresh lettuce in the cooler drawer.

On the allegation: Staff screams at residents


In an interview with W1 they stated that they have heard staff raise their voice at residents and speak to some residents including R2 and R3 in an unkind manor. In an interview it was stated that some of the staff have even pinched R3’s nose.

Based on LPAs interviews, 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. Failure to submit proof of correction by plan of correction due date, and any repeat violations within a 12-month period may result in civil penalties. Exit interview conducted, and a copy of this report provided.

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

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
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
07/17/2025 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20250717104148

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:
11/07/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Lailo Matias, LicenseeTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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9
Resident sustained unexplained injuries
Staff are handling residents in a rough manner
INVESTIGATION FINDINGS:
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 On 11/07/2025 at 11:00 AM, Licensing Program Analysts (LPA), J. Clancy-Czuleger arrived unannounced to deliver complaint findings for the above allegations. LPA met with Lailo Matias, Administrator and explained the reason for the visit.

During the course of investigation, LPA obtained information, collected documents and interviewed staff and residents. Based on interview with Staff, S1 and S2 both stated that all staff treat R1 with respect and enjoy talking to R1. When asked about joking around or poking fun at residents, both S1 and S2 explained that they like to try and make residents laugh when working with them but not to make fun of or be mean to them.
On the allegation: Resident sustained unexplained injuries

Continued on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20250717104148
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: 11/07/2025
NARRATIVE
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... Continued from 9099A

R1 was observed one morning to have a broken tooth. Facility staff were interviewed and said that there had been no incident or altercation that had occurred that would have broken R1’s tooth. W1 was interviewed and stated that they were informed about the tooth the same morning that it was noticed by staff and did not believe an injury or altercation occurred, but that staff might not be brushing R1’s teeth well enough. R1 was taken to the dentist, and it was confirmed that the tooth had broken due to rotting away and not from an injury.



On the allegation: Staff are handling residents in a rough manner

It was observed that R1 had scratches on their arm. W1 said that they also noticed the scratches on R1’s arm but was informed by staff that R2 had grabbed R1 and that was what may have caused the scratches. W1 said that they have not seen any staff handle the residents in a rough manner.

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: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20250717104148
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: 11/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/14/2025
Section Cited
CCR
87555(b)(26)
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The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by:
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Licensee, agreed to purchase food and submit photo and receipt to CCLD by POC date.
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Based on observation, the licensee did not comply with the section cited above by not having two days of perishable foods or one week of nonperishable foods, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
11/14/2025
Section Cited
CCR
87468.1(a)(3)
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Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature...This requirement is not met as evidenced by:
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Administrator agreed to train all staff regarding the citations. Copy of training will be send to CCL by POC due date.
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Based on interviews, the licensee did not comply with the section cited above by staff raising their voice at residents and pinching a residents nose, which poses/posed a potential health, safety or personal rights risk to persons 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: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5