079200612-7-3-2025-15-AS-KHOS-DJMPP5-20250716112858

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200612
Report Date: 07/03/2025
Date Signed: 07/03/2025 12:13:26 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
03/20/2025 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20250320145107

FACILITY NAME:	WOODLAND HOME		FACILITY NUMBER:	079200612
ADMINISTRATOR:	SALDANA, VICKI L		FACILITY TYPE:	740
ADDRESS:	4219 WOODLAND DRIVE		TELEPHONE:	(925) 349-5514
CITY:	CONCORD	STATE: CA	ZIP CODE:	94521
CAPACITY:	4	CENSUS: 4	DATE:	07/03/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Denise Mansfield, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff do not provide appropriate showering equipment for a resident
Staff do not meet the residents showering needs
Staff are sleeping during the night shift
Staff are not providing adequate care and supervision to the residents
Staff are not meeting the residents diapering needs
Staff are being treated with ammonia
Staff mishandled the residents medications

INVESTIGATION FINDINGS:

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On 7/03/25 at 10:30 a.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings in regard to the allegations above. LPA met with Denise Mansfield, Administrator and explained the purpose of the visit.

During the course of the investigation LPA interviewed W1, facility staff, toured facility and reviewed facility records.

Allegation: Staff do not provide appropriate showering equipment for a resident

W1 alleged that R1 did not have adequate equipment in his bathroom to shower safely. Facility staff (S1 & S2) stated that there are no issues with R1 using the shower safely. R1 has his preferred shower which he uses with minimal assistance. LPA observed R1’s shower to be adequately furnished with grab bars and shower chair.
***report continues on LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20250320145107

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: WOODLAND HOME	FACILITY NUMBER: 079200612
	VISIT DATE: 07/03/2025

NARRATIVE

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***report continues from LIC9099***

Allegation: Staff do not meet the residents’ showering needs

S1 and S2 stated that all the residents are on a showering schedule and receive at least 3 showers a week and more as needed. LPA reviewed residents’ care notes that indicate showers happen according to schedule.

Allegation: Staff are sleeping during the night shift

S3 and S4 work the overnight shifts at the facility. Both S3 and S4 denied ever seeing staff sleep on the overnight shift. S1 also stated that she has never received a complaint about staff sleeping while on duty except from W1. S1 investigated W1’s allegation and found it not to be true.

Allegation: Staff are not providing adequate care and supervision to the residents

Interviews with facility staff revealed that they all felt that there are enough staff to provide adequate care and supervision for the residents. During waking hours there are 3 staff on duty for the 4 residents along with the House Manger and Administrator.

Allegation: Staff are not meeting the residents’ diapering needs

S1 and S2 stated that the incontinent residents at the facility are changed every 3 hours or more as needed. LPA observed the residents to be clean, nicely dressed and free of odor. The facility was also free of odor. Facility staff also reported that they change the residents diapers as scheduled or when the residents’ have a need.

Allegation: Staff are being treated with ammonia

W1 stated that the residents’ diapers smell like ammonia and that she suspects staff are using ammonia to clean residents. All facility staff deny ever using ammonia to clean the residents. LPA observed the residents to be clean, well dressed and odor free. Inspection of the facility revealed that there is no ammonia on site.

Allegation: Staff mishandled the residents’ medications

W1 couldn’t remember any specific incidents when medication was mismanaged but wanted LPA to check into it. LPA interviewed staff and reviewed medication administration records (MARS) for January, February and March 2025 and found no irregularities.

This agency has investigated the above allegations, we have found that the allegations are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025

LIC9099 (FAS) - (06/04)

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