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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201105
Report Date: 02/27/2025
Date Signed: 02/27/2025 03:17:57 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
02/24/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20250224150432
FACILITY NAME:CARING HEARTS ELDERLY HOMEFACILITY NUMBER:
079201105
ADMINISTRATOR:SANTOS VAHID, ELVIRAFACILITY TYPE:
740
ADDRESS:3498 SWALLOW COURTTELEPHONE:
(925) 948-5221
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:6CENSUS: DATE:
02/27/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Elvira Vahid, Administrator
TIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff failed to provide a regular bed to resident in care upon admission
Licensee did not provide a refund upon resident's death
INVESTIGATION FINDINGS:
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On 02/27/25 at 12:30PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with administrator (ADM), gathered information on the allegations and delivered investigation findings to ADM. LPA explained the purpose of the visit with ADM.

During investigation, the department obtained the following documents from administrator – personnel record, residents’ roster, admission agreement, physician’s report, pre-placement appraisal, progress notes, hospital discharge report, medication administration records.

Continued on next page, LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
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-20250224150432
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: CARING HEARTS ELDERLY HOME
FACILITY NUMBER: 079201105
VISIT DATE: 02/27/2025
NARRATIVE
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Allegation: Staff failed to provide a regular bed to resident in care upon admission
Finding: Unsubstantiated
During investigation, LPA interviewed staff (ADM) who stated that resident (R1) and responsible party (POA) toured the facility on 12/02/24 and 01/08/25 and paid $1K to hold bedroom# 3 for R1. LPA reviewed photos of bedroom# 3 taken by ADM on 01/08/25 which showed a dresser, chair and bed inside. ADM stated that POA requested the bed and chair removed because they are of no use to R1 due to his health condition. POA delivered R1’s recliner chair and purchased a new bed which was supposed to be delivered to the facility on 01/17/25 but ended up being delivered on 01/28/25. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that staff failed to provide a regular bed to resident in care upon admission was found to be unsubstantiated.

Allegation: Licensee did not provide a refund upon resident’s death
Finding: Unsubstantiated
During investigation. LPA interviewed staff (ADM, S1) and reviewed former resident’s (R1’s)/responsible party’s (POAs) documents. Review of R1’s documents showed that R1 moved into the facility on 01/22/25, was admitted to the hospital on 01/27/25 and returned to the facility on 01/29/25 where he passed away a few hours later. POA stated they collected R1’s personal belongings on 01/30/25. POA stated that a total advance payment of $8K was given to ADM on 01/22/25 for January move-in and February advance payment of $6K. POA sent ADM an email dated 01/30/25 requesting refund of $6K February advance payment and compensation for new hospital bed purchased ($1300). On 02/05/25, ADM agreed to refund POA the February advance payment of $6K but did not compensate for the new hospital bed. On 02/06/25, POA donated R1’s new hospital bed, electric recliner, chair covers, diapers, pads, case of Ensure and beddings to the facility. On 02/22/25, R1’s family picked up the $6K refund check from ADM for February advance payment. LPA reviewed total amount paid ($8K) by POA and determined that ADM still owes POA a total of $312 as final reimbursement of advance payment made ($2K minus $1688 equals $312). ADM issued a check of $312 to POA on 02/27/25. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that licensee did not provide a refund upon resident’s death was found to be unsubstantiated.

No deficiency cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC9099 (FAS) - (06/04)
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