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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200924
Report Date: 12/15/2025
Date Signed: 12/15/2025 01:27:50 PM

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
12/05/2025 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20251205101323
FACILITY NAME:A OHANA HOME FOR SENIORS, LLCFACILITY NUMBER:
079200924
ADMINISTRATOR:MALEKAMU, MARYFACILITY TYPE:
740
ADDRESS:1841 FLORENCE LNTELEPHONE:
(925) 698-1736
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY:6CENSUS: 5DATE:
12/15/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rose Malekamu, House ManagerTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff left residents unattended
INVESTIGATION FINDINGS:
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On 12/15/2025 at 9:00AM, Licensing Program Analysts (LPAs) Kelly Nguyen and Andrew Christy arrived unannounced to conduct 10-day initial complaint and deliver for the above allegation and met with house manager, Rose Malekamu, and explain the purpose of the visit. During the investigation house manager had to leave and gave verbal permission to the care staff, Teresa Caal, to sign the report.

During the course of the investigation, LPAs conducted file review, including but not limited to, resident roster, staff schedule, staff shift record log, staff communication via text, and residents’ records. LPAs also conducted interviews with residents and staff.

Report Continued on LIC 9099c...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2025
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 3
Control Number 15-AS-20251205101323
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: A OHANA HOME FOR SENIORS, LLC
FACILITY NUMBER: 079200924
VISIT DATE: 12/15/2025
NARRATIVE
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Allegation: Staff left residents unattended - Substantiated

Based on record reviews and interviews Staff 1(S1) was on duty during 12/3/25 from 5pm to 10pm. However, at around 9:30pm S1 left the facility and confirmed by Staff 2 (S2) S1 was outside the facility. Staff 3 (S3) confirmed S3 arrived at the facility either at 10pm or around 10pm. LPAs interviewed Resident 1 (R1), Resident 2 (R2), Resident 3 (R3), Resident 4 (R4), and attempted to interview Resident 5 (R5) at the facility. R1, R2, R3, and R4 stated there are times that the facility has no staff available. Therefore, the above allegation is substantiated due to staff left residents unattended.

The preponderance of the evidence standard has been met, and the allegation is SUBSTANTIATED.
Deficiency is cited under the California Code of Regulations listed on LIC 9099-D. Failure to submit proof of correction (POC) by plan of correction and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted appeal rights and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 15-AS-20251205101323
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: A OHANA HOME FOR SENIORS, LLC
FACILITY NUMBER: 079200924
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/22/2025
Section Cited
CCR
87464(f)(1)
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87464 Basic Services
(f) Basic services shall at a minimum include:
(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).

-This requirement is not met as evidenced by:
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On or before plan of correction due date, licensee will submit an updated LIC500 and staff schedule that will mitigate gaps of coverage in case of staff running behind.
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-Based on record review and interviews, the licensee did not comply with the section cited above by leaving the residents unattended.
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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: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3