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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200302
Report Date: 03/26/2025
Date Signed: 03/26/2025 10:24:14 AM

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
12/12/2024 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20241212151031
FACILITY NAME:STUART HOUSE, THEFACILITY NUMBER:
079200302
ADMINISTRATOR:PAMELA GREENFACILITY TYPE:
740
ADDRESS:3067 BELFAST WAYTELEPHONE:
(510) 262-0206
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY:6CENSUS: 4DATE:
03/26/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Pamela Green, AdministratorTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Facility staff did not provide care for resident personal accommodations.
INVESTIGATION FINDINGS:
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On 03/26/25 around 08:30 AM L. Holmes, Licensing Program Analyst (LPA), arrived unannounced to deliver the findings for the above allegations. LPA met with Pamela Green, Administrator and explained the purpose of the visit.
LPA toured the facility, interviewed Staff (S1, S2, S3) and Residents (R1, R2, R3, R4, R5). LPA requested the facility’s Resident Roster, Personnel Report (LIC500) and the following for Residents (R1, R2, R3, R4, R5): current Physician's Report, ID/Emergency Contact information, Resident Appraisal, House Rules and Unusual Incident Reports (UIRs) from 10/2024 to 12/2024.

Allegation: Facility staff did not provide care for resident personal accommodations.
R1 stated that the bulb was missing from the lamp in his/her room and R1 was trying to reach for the lamp in the dark. R1 stated that he/she was fearful. LPA toured the facility and noted that the light switches in the resident’s rooms were secured by clear locked boxes, and room number (1) bedside lamp was not plugged into the wall.
Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
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-20241212151031
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: STUART HOUSE, THE
FACILITY NUMBER: 079200302
VISIT DATE: 03/26/2025
NARRATIVE
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...continued from LIC9099.

Based on LPA’s observations, interviews and records reviewed, the preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED. Deficiency is cited from Title 22 California Code of Regulations and listed on LIC9099D. 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, appeal rights and a copy of this report provided to Pamela ADM.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20241212151031
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: STUART HOUSE, THE
FACILITY NUMBER: 079200302
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/28/2025
Section Cited
CCR
87307(a)(3)(B)
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(a) Living accommodations...shall apply: (3)...necessary for personal care and maintenance…the licensee shall assure provision of: (B) Bedroom...for each resident, a chair, night stand, a lamp, or lights sufficient for reading...
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Administrator/Licensee agreed to review the regulation and made the correction during the visit on 12/16/24.
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-This requirement is not met as evidenced by:
Based on observations and interviews, the licensee did not comply with the section cited above by not having the lamp plugged in which poses/posed a potential health and safety 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: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC9099 (FAS) - (06/04)
Page: 3 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
12/12/2024 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20241212151031

FACILITY NAME:STUART HOUSE, THEFACILITY NUMBER:
079200302
ADMINISTRATOR:PAMELA GREENFACILITY TYPE:
740
ADDRESS:3067 BELFAST WAYTELEPHONE:
(510) 262-0206
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY:6CENSUS: 4DATE:
03/26/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Pamela Green, AdministratorTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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9
Facility staff slapped resident.
Facility staff yelled at resident.
Facility staff do not allow resident to use personal possessions without permission.
INVESTIGATION FINDINGS:
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On 03/26/25 around 08:30 AM L. Holmes, Licensing Program Analyst (LPA), arrived unannounced to deliver the findings for the above allegations. LPA met with Pamela Green, Administrator and explained the purpose of the visit.

LPA toured the facility, interviewed Staff (S1, S2, S3) and Residents (R1, R2, R3, R4, R5). LPA requested the facility’s Resident Roster, Personnel Report (LIC500) and the following for Residents (R1, R2, R3, R4, R5): current Physician's Report, ID/Emergency Contact information, Resident Appraisal, House Rules and Unusual Incident Reports (UIRs) from 10/2024 to 12/2024.

Continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
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 5
Control Number 15-AS-20241212151031
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: STUART HOUSE, THE
FACILITY NUMBER: 079200302
VISIT DATE: 03/26/2025
NARRATIVE
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...continued fron LIC9099A

Facility staff slapped resident.
R1 reported to W1 that S1 slapped him/her on the right side of the face. LPA interviewed R1 and R1 stated that he/she had been slapped by his/her sister many years ago. R1 stated that he/she was never hit by S1 or S2. On 03/18/25, LPA received a call from W1 stating that R1 wanted to retract his/her statement and that R1 was confused. R1 is diagnosed with Dementia.

Facility staff yelled at resident.
S1 and S2 stated that they do not yell at the residents. S3 stated that R3 and R1 yells sometimes. S3 will ask R1 to wait a few seconds. LPA asked R1 if S1 or S2 had yelled at him/her, R1 stated, “No, they are sensible people.” When asked again, S1 stated that he/she could not pinpoint that.

Facility staff do not allow resident to use personal possessions without permission.
LPA toured the facility, and all residents’ personal items, clothing, and shoes were unlocked and accessible to staff and residents. R1 stated that anything helpful disappears. R2 stated that S1 keeps the house clean. R3 stated that he/she doesn't have anything to bother and R5 stated he/she loves to read and that’s not a problem. W2 stated that S1

Based on LPA’s observations, interviews and records reviewed, the preponderance of evidence standard has not been met; therefore, the above allegations are UNSUBSTANTIATED.
Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5