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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200921
Report Date: 01/14/2026
Date Signed: 01/14/2026 04:17:24 PM

Unsubstantiated


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
09/18/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250918134246
FACILITY NAME:A FAMILY OF CAREFACILITY NUMBER:
079200921
ADMINISTRATOR:TAYLOR, KATHLEENFACILITY TYPE:
740
ADDRESS:1945 ST MARTIN PLACETELEPHONE:
(510) 755-7810
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:6CENSUS: 7DATE:
01/14/2026
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Zariah Charles, House Manager TIME COMPLETED:
04:35 PM
ALLEGATION(S):
1
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9
Staff leave residents in bed for extended periods of time.
Staff wrongfully evicted resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
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9
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On 01/14/2026 at 3:30PM Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to conduct an investigation and deliver complaint findings for allegations above. LPA met with Zariah Charles, House Manager, and explained the reason for the visit.

Allegation: Staff wrongfully evicted resident.
Interviews with S1, S2 and W1 revealed R1 was not evicted from the facility. R1 was removed from the facility by family member. Record review revealed R1 was not evicted, W1 removed R1 from the facility.

Continue on LIC9099C.....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
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-20250918134246
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: A FAMILY OF CARE
FACILITY NUMBER: 079200921
VISIT DATE: 01/14/2026
NARRATIVE
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Continued from LIC9099


Allegation: Staff leave residents in bed for extended periods of time.

Interviews with S1 and S2 revealed there is no set bedtime for the residents, residents usually go into their rooms around 8:30pm, after dinner and evening activities. Interviews with R2, R3 and R4 revealed there is not a set bedtime for residents and residents are allowed to get out of bed as they like.

Based on interviews conducted and records reviewed, the preponderance of evidence standard has not been met, therefore the allegation is found to be UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it did or did not occur.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2