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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601335
Report Date: 02/11/2025
Date Signed: 02/11/2025 11:35:23 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
12/11/2024 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20241211150341
FACILITY NAME:GREENLEAF CARE HOMEFACILITY NUMBER:
075601335
ADMINISTRATOR:BANGI, ANGELINE SFACILITY TYPE:
740
ADDRESS:783 GREENLEAF DRIVETELEPHONE:
(925) 240-9091
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:6CENSUS: 4DATE:
02/11/2025
UNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Katherine Buenaflor, CaregiverTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Financial Abuse
Staff threatened to fight resident
INVESTIGATION FINDINGS:
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On 02/11/2025 at 11:00AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to deliver complaint findings for the allegations above. Upon arrival, LPA met with Katherine Buenaflor, Caregiver and explained to her the reason for the visit. Katherine contacted Administrator, Liezyl Ajos via telephone. Administrator, Liezyl Ajos arrived at 11:18AM, LPA explained purpose of visit.

During the course of the investigation, the Department conducted interviews with staff, R1’s daughter and complainant. Resident’s physician's report, R1's after visit summary dated 12/02/2024, admission agreement and appraisal need, and services plan records were obtained and reviewed. LPA couldn’t interview R1 due to R1 being diagnosed with dementia.

Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
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-20241211150341
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: GREENLEAF CARE HOME
FACILITY NUMBER: 075601335
VISIT DATE: 02/11/2025
NARRATIVE
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Continued from LIC9099


Allegation: Financial Abuse:

Based on interviews with staff and R1's daughter. R1’s daughter stated the money R1 receives monthly from Supplemental Security Income (SSI), is sent directly to the facility and that R1 has no contact with money at all. Staff stated they have not seen R1 with money since she’s been at the facility and that staff spends their own money on R1 when they would take R1 out into the community.

Allegation: Staff threatened to fight resident.

Based on file review and interview, R1’s physician report dated 05/29/2024 revealed that R1 has dementia, confused and disoriented. Based on interview, R1’s daughter stated that R1 has suffered severe brain damage for over forty (40) years and as a result R1 has extremely aggressive behavior and can be difficult to work with at times.

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




Exit interview conducted and a copy of this report provided to Administrator, Liezyl Ajos.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2