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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601236
Report Date: 06/05/2025
Date Signed: 06/05/2025 03:44:26 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
05/14/2025 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20250514132244
FACILITY NAME:SEIKO'S PLACEFACILITY NUMBER:
075601236
ADMINISTRATOR:LINSZKY, SEIKOFACILITY TYPE:
740
ADDRESS:4967 HAMES DRIVETELEPHONE:
(925) 676-8963
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:6CENSUS: 5DATE:
06/05/2025
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Gladys Corpuz/StaffTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff left the residents unattended.
INVESTIGATION FINDINGS:
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On this day, June 5, 2025, at 2:20 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to deliver the findings for the above allegation. LPA met with Gladys Corpuz, staff. LPA called and spoke over the phone with House Manager (HM) Mateaki 'Mat' Ofenhengaue who stated he can not come to the facility and gave permission to Gladys Corpuz to sign and receive this report.

During the course of investigation, LPA conducted interviews. LPA reviewed residents' files and obtained copies of the following residents' documents: LIC602A Physician's Reports; hospital After Visit Summary. LPA also obtained copies of LIC9020 Register of Facility Clients/Residents, staff schedule and contact information. LPA interviewed the following: reporting party (RP) on 5/16/25; staff (HM) on 5/22/25; staff (S3) on 5/28/25.

.....continued on 9099C (page 2)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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-20250514132244
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: SEIKO'S PLACE
FACILITY NUMBER: 075601236
VISIT DATE: 06/05/2025
NARRATIVE
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Page 2

It was alleged that when resident’s (R1) family member went to the facility on 5/01/25, the staff was in the shower, and it was resident (R2) who opened the door.

HM stated that R1's wife (FM1) was at the facility on 5/01/25 at around 6:30 pm, then left and came back. HM further stated that S3 was in the shower at the time when FM1 came back, and it was R2 who opened the door. S3 confirmed she was by herself and was taking shower and it was R2 who opened the door for FM1. Review of records showed R2 has major neuro cognitive disease and has wandering behavior.

Based on interviews and records review, the preponderance standard has been met, therefore, the allegation is substantiated.

Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of correction by plan of correction due date along with the LIC9098 Proof of Correction form and any repeat violation within 12 month period may result in civil penalty

Deficiency and plan and proof of correction were discussed with HM over the phone.

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 15-AS-20250514132244
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: SEIKO'S PLACE
FACILITY NUMBER: 075601236
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/06/2025
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs……...............
-This requirement is not met as evidenced by:
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Administrator to in-service the staff and submit copy of training topic with attendees signatures by 6/06/25.
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-Based on record review and interviews, the licensee did not comply with the section above when staff left the residents unattended which posed an immediate safety and/or personal rights risks 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: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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
05/14/2025 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20250514132244

FACILITY NAME:SEIKO'S PLACEFACILITY NUMBER:
075601236
ADMINISTRATOR:LINSZKY, SEIKOFACILITY TYPE:
740
ADDRESS:4967 HAMES DRIVETELEPHONE:
(925) 676-8963
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:6CENSUS: 5DATE:
06/05/2025
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Gladys Corpuz/StaffTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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- Staff are not providing adequate care and supervision of a resident.

- Staff mishandled a resident.
INVESTIGATION FINDINGS:
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On this day, June 5, 2025, at 2:20 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to deliver the findings for the above allegation. LPA met with Gladys Corpuz, staff. LPA called and spoke over the phone with House Manager (HM) Mateaki 'Mat' Ofenhengaue who stated he can not come to the facility and gave permission to Gladys Corpuz to sign and receive this report.

During the course of investigation, LPA conducted interviews. LPA reviewed residents' files and obtained copies of the following residents' documents: LIC602A Physician's Report; hospital After Visit Summary. LPA also obtained copies of LIC9020 Register of Facility Clients/Residents, staff schedule and contact information. LPA interviewed the following: reporting party (RP) on 5/16/25; staff (S1, S2 and HM) and residents (R1, R2, R3, R4, R5) on 5/22/25; staff (S3) on 5/28/25. LPA obtained information from the resident’s family member (FM1) on 5/22/25.

.....continued on 9099C (page 2)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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-20250514132244
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: SEIKO'S PLACE
FACILITY NUMBER: 075601236
VISIT DATE: 06/05/2025
NARRATIVE
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Page 2

Allegation: Staff are not providing adequate care and supervision of a resident (R1).
It was reported that R1 had fallen out of bed and when FM1 came to the facility on 5/01/25, FM1 found R1 in poor condition and FM1 called 9-11.

S1 and S3 stated they were not in the facility when FM1 called 9-11 and R1 was sent out. S1 stated R1 came back the following day. HM stated he talked to FM1 and asked why she wants to call 9-11 and FM1 said R1 does not look good. HM further stated the ambulance came, checked and took R1 vitals and didn't see anything but FM1 insisted to have R1 sent out.

FM1 stated she does not have complaint about the care R1 is getting from the facility and that R1 did not fall out of bed. LPA interviewed and verified with RP who stated R1 was diagnosed with weakness and was discharged back to the facility the following. Review of hospital After Visit Summary dated 5/02/25 indicated the following: no admission diagnosis during encounter; no admission procedures for hospital encounters; no comments available. R1 was not able to provide information regarding the incident. Therefore, the allegation is unsubstantiated.

Allegation: Staff mishandled a resident.
It was alleged that when R1 asked staff to speak English, the staff lifted R1 up by R1’s shirt and put R1 back to bed and that R1 appeared upset.

S1 stated that he was getting/preparing and giving R1 morning care when the incident happened. R1 was out balanced and about to fall and his immediate reflex was to catch R1, so he hold R1 onto his shirt to prevent him from falling. S1 denied handling any residents roughly. S1 and S3 also denied handling any residents roughly and stated not observing S1 handled the residents roughly. Three out of 5 residents stated all the staff are nice and never handled them roughly. Due to medical diagnosis, LPA was unable to obtain information from the other 2 residents on how they are handled and/or assisted by the staff. Therefore, the allegation in unsubstantiated.

.....continued on 9099C (page 3)
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 15-AS-20250514132244
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: SEIKO'S PLACE
FACILITY NUMBER: 075601236
VISIT DATE: 06/05/2025
NARRATIVE
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Page 3

A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiency cited.

Exit interview conducted and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC9099 (FAS) - (06/04)
Page: 6 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
05/14/2025 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20250514132244

FACILITY NAME:SEIKO'S PLACEFACILITY NUMBER:
075601236
ADMINISTRATOR:LINSZKY, SEIKOFACILITY TYPE:
740
ADDRESS:4967 HAMES DRIVETELEPHONE:
(925) 676-8963
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:6CENSUS: 5DATE:
06/05/2025
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Gladys Corpuz/StaffTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff does not communicate effectively.
INVESTIGATION FINDINGS:
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On this day, June 5, 2025, at 2:20 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to deliver the findings for the above allegation. LPA met with Gladys Corpuz, staff. LPA called and spoke over the phone with House Manager (HM) Mateaki 'Mat' Ofenhengaue who stated he can not come to the facility and gave permission to Gladys Corpuz to sign and receive this report.

During the course of investigation, LPA obtained copies of staff schedule and interviewed the 4 staff 5/22/25 and 5/28/25. LPA conducted interviews in English and all the staff were able to speak/talk in English, therefore, the allegation in unfounded.

No deficiency cited.

Exit interview conducted and copy of this report provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 7 of 7