079200801-2-27-2026-15-AS-BFOG-DSA4YE-20260317193100

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200801
Report Date: 02/27/2026
Date Signed: 02/27/2026 01:20:45 PM

Unfounded

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
12/22/2025 and conducted by Evaluator Alona Gomez

COMPLAINT CONTROL NUMBER: 15-AS-20251222115507

FACILITY NAME:	WESTMONT OF PINOLE		FACILITY NUMBER:	079200801
ADMINISTRATOR:	REMIGIO, RICHARD		FACILITY TYPE:	740
ADDRESS:	2850 ESTATES AVE		TELEPHONE:	(510) 758-1122
CITY:	PINOLE	STATE: CA	ZIP CODE:	94564
CAPACITY:	100	CENSUS:	DATE:	02/27/2026
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Interium Executive Director, Benjie Doctolero		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff neglected resident after a fall
Facility did not provide adequete incidental medical care
Staff not competent to provide care

INVESTIGATION FINDINGS:

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On 2/27/2026 at 10:30AM, Licensing Program Analyst (LPA), A Gomez arrived unannounced to deliver complaint investigation findings for the complaint allegations above. LPA met with Interium Executive Director, Benjie Doctolero and explained the reason for the visit

During the course of the investigation LPA reviewed documents icluding but not limited to R1's care notes, Unusual incident reports, careplan and conducted interviews with staff and resident. LPA attempted to interview W1 however they were unavailable

report continues on LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026

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-20251222115507

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: WESTMONT OF PINOLE	FACILITY NUMBER: 079200801
	VISIT DATE: 02/27/2026

NARRATIVE

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On the allegations "Staff neglected resident after a fall, Facility did not provide adequate incidental medical care, and Staff not competent to provide care" the following was found:

LPA conducted interviews and reviewed records. It was alleged that R1 sustained a fall in their room on 9/12/2025 that resulted in injury and that S1 was present at the time of the fall and did not provide assistance after the fall. It was also alleged that R1 was sent out to the hospital on this date and that police were notified because S1 alleged that R1 sexually assaulted them. Through record review and interview LPA found that S1 did not provide any type of in room assistance to R1 and that their position does not provide care. S1 also stated that they were not aware of any falls with R1 because they do not provide care and that they never alleged R1 or anyone else at the facility assaulted them in any way. LPA also interviewed the previous Executive Director who corroborated that S1 has never been alone with R1 and that S1 does not provide care or go to residents room. Previous ED also stated that there was a history of R1 making false claims against S1. LPA was unable to identify any information to support any of the claims made in the complaint. LPA observed that staff reviewed were up to date on their required training for their position. LPA attempted to interview W1 via phone call however LPA was unable to reach them. LPA also contacted R1's medical provider who stated there are no records of them visiting the emergency room in September 2025. Before delivering findings LPA received a phone call with additional confidential information. Therefore the above allegations are UNFOUNDED.

This agency has investigated the complaint alleging Staff neglected resident after a fall, Facility did not provide adequate incidental medical care, and Staff not competent to provide care. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026

LIC9099 (FAS) - (06/04)

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