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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601535
Report Date: 04/12/2021
Date Signed: 04/12/2021 03:37:54 PM

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
03/19/2020 and conducted by Evaluator Laura Hall
COMPLAINT CONTROL NUMBER: 15-AS-20200319163431
FACILITY NAME:CARTER PLACEFACILITY NUMBER:
075601535
ADMINISTRATOR:SALINAS, TOMASFACILITY TYPE:
740
ADDRESS:27 CARTER CT.TELEPHONE:
(510) 223-1696
CITY:EL SOBRANTESTATE: CAZIP CODE:
94803
CAPACITY:6CENSUS: 6DATE:
04/12/2021
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Tomas Salinas, AdministratorTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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9
Facility illegally evicted resident.
INVESTIGATION FINDINGS:
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On 04/12/2021 at 03:10pm, Licensing Program Analyst (LPA), L. Hall conducted and unannounced visit via telephone to deliver complaint findings of the above allegation. LPA spoke with Tomas Salinas, Administrator, and explained the reason for the call. LPA explained due to the present shelter-in-place order by the Governor, the complaint investigation is being done over the phone.

During the course of the investigation, LPA interviewed 2 staff, 2 out of the 6 residents, 2 witnesses, and obtained the resident’s and facility’s roster.

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

DATE: 04/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021
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-20200319163431
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: CARTER PLACE
FACILITY NUMBER: 075601535
VISIT DATE: 04/12/2021
NARRATIVE
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Continued from LIC9099.

During the interviews 1 staff indicted that he did hear S1 have a conversation about a resident moving out of the facility, but that was during a conversation with the resident’s family. W2 stated that S1 did not threaten to evict R1. R1’s behavior wasn’t acceptable and S1 had a conversation with R1.

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

Exit interview conducted. A copy of this report provided by email.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2