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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200924
Report Date: 02/17/2026
Date Signed: 02/17/2026 11:05:16 AM

Substantiated


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
01/20/2026 and conducted by Evaluator Andrew Christy
COMPLAINT CONTROL NUMBER: 15-AS-20260120143023
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: 6DATE:
02/17/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:TIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Licensee not providing prompt access to or copies of resident records.
INVESTIGATION FINDINGS:
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On 02/17/2026 at 9:30AM, Licensing Program Analysts (LPAs) Andrew Christy and Ardalan Gharachorloo arrived unannounced to deliver findings for the above allegation. LPAs met with Administrator Mary Mataele and explained the purpose of the visit.

Allegation: Licensee not providing prompt access to or copies of resident records - Substantiated
LPA Andrew Christy received the email correspondence from RP, which lays out the time frame that documents were requested. RP is the legal representitive of W1 and has authority to request documents in regards to W1 and the resident that was staying (R1). Email correspondence showed that S1 did not provide the documents over a two month period despite constant communication. The preponderance of the evidence standard has been met, and the allegation is SUBSTANTIATED.

Continued on LIC9099C.....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Andrew Christy
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026
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 3
Control Number 15-AS-20260120143023
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 OHANA HOME FOR SENIORS, LLC
FACILITY NUMBER: 079200924
VISIT DATE: 02/17/2026
NARRATIVE
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Continued from LIC9099.....

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: Harpreet Humpal
LICENSING EVALUATOR NAME: Andrew Christy
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20260120143023
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 OHANA HOME FOR SENIORS, LLC
FACILITY NUMBER: 079200924
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/17/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2026
Section Cited
CCR
87468.2(a)(19)
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To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days...
- This requirement is not met as evidenced by:
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On or before plan of correction due date, Licensee will send an email of the requested documents to the RP and will include CCL in the email as proof
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Based on interviews and record review, the authorized representative has not received records in two months since the initial request.
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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: Harpreet Humpal
LICENSING EVALUATOR NAME: Andrew Christy
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3