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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200855
Report Date: 08/15/2025
Date Signed: 09/17/2025 02:10:46 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
08/13/2025 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20250813123748
FACILITY NAME:TODOS SANTOS ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
079200855
ADMINISTRATOR:CLAWSON, DAVID JFACILITY TYPE:
740
ADDRESS:1081 MOHR LNTELEPHONE:
(925) 798-3900
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:160CENSUS: 132DATE:
08/15/2025
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:David Clawson, DirectorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff mishandled a resident's medication
Staff did not ensure a resident consumed an appropriate amount of liquid
Staff did not timely address a resident's change in medical condition
INVESTIGATION FINDINGS:
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On 08/15/2025 at 11:10AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to conduct a complaint visit. LPA explained the purpose of the visit with Administrator David Clawson.

During the initial 10-day complaint visit, LPA interviewed staff, collected the following documents: R1's Care notes, R1's Phisicains report, R1's admissions agreement, R1's MAR's, and R1's incident reports.

On the allegation: Staff mishandled a resident's medication. On 7/14/2025 the facility followed discharge order for R1 to stop buprenorphine-naloxone 8-2 mg Subl (SUBOXONE) along with four other medications.

On the allegation: Staff did not ensure a resident consumed an appropriate amount of liquid. The memory care staff remind all residents in care to drink water and other liquids throught the day. R1 did not have discharge instructions for additional liquids or monitoring of liquids.

Continued on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
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-20250813123748
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: TODOS SANTOS ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 079200855
VISIT DATE: 08/15/2025
NARRATIVE
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... Continued from LIC 9099

On the allegation: Staff did not timely address a resident's change in medical condition. On 8/9/2025 when facility staff observed that R1 was confused and Lethargic they notified R1's family and PCP. R1 was taken to the hospital and evaluated where it was found that R1 had a UTI.

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

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2