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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201134
Report Date: 01/30/2025
Date Signed: 01/30/2025 05:36:05 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
05/13/2024 and conducted by Evaluator Laura Hall
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240513172348
FACILITY NAME:ANGEL CARE HOMEFACILITY NUMBER:
079201134
ADMINISTRATOR:WANG, DINGFACILITY TYPE:
740
ADDRESS:1723 LIMEWOOD PLACETELEPHONE:
(925) 635-3936
CITY:PITTSBURGSTATE: CAZIP CODE:
94553
CAPACITY:6CENSUS: 4DATE:
01/30/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Rosalita Constantino, CaregiverTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Financial abuse

Family is not notified of incidents involving resident..

Facility increased resident's fees without proper notification.
INVESTIGATION FINDINGS:
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On 1/30/2025 at 1:30pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint findings for the allegations above. LPA met with Rosalita Constantino and explained the reason for the visit. LPA spoke with Administrator, Ding Wang, via telephone.

During the course of the investigation the Department conducted interviews with staff, witnesses, obtained and reviewed records.

Allegation: Financial abuse

Based on initial interview with W1, R1 had completed two withdrawal transactions of

Continued on LIC9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
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-20240513172348
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: ANGEL CARE HOME
FACILITY NUMBER: 079201134
VISIT DATE: 01/30/2025
NARRATIVE
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Continued from LIC9099.

$250.00 each at Wal-Mart, yet when R1 expired the money was not found. W1 also stated there was conversation regarding money for incontinence products between R1 and S1. S1 stated during interview there was a conversation to pay more for incontinence products and R1’s cat, but S1 stated she never received any additional money. S1 stated R1 and S2 had went to the bank and obtained cash. S1 also had knowledge that R1 had bought candy and clothes. S2 stated during interview that he went with R1 to Wal-Mart two days. S2 recalled R1 had obtained money during the outing and bought candy. S2 stated that R1 had given him $100.00, and he gave $20.00 back to R1. Based on interviews R1 handled her own money, furthermore there is not enough evidence to prove any financial abuse.

Allegation: Family is not notified of incidents involving resident.

W1 stated during initial interview that a witness was told by the Pittsburg Police Department that R1 had recently been discharged from a hospital in Modesto. W1 stated the facility did not notify the family about any hospitalization. W1 was not able to give an exact date, but it was approximately two weeks prior to R1 expiring. W3 stated there was an after-summary visit document dated May 7, 2024, along with medications sitting on the dresser of R1’s room. During record review of the after-summary visit from Pittsburg Health Center Family Medicine it indicated the visit was a follow-up visit from a hospital. The summary did not specify when R1 visited the hospital or which hospital was visited. S1 stated she was not aware of R1 going to a hospital in Modesto. S1 did not have any documentation for R1.

Continued on LIC9099C.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20240513172348
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: ANGEL CARE HOME
FACILITY NUMBER: 079201134
VISIT DATE: 01/30/2025
NARRATIVE
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Continued on LIC9099C.

Allegation: Facility increased resident's fees without proper notification.

During initial interview W1 stated S1 admitted a conversation was held between S1 and R1 regarding paying more money to the facility for extra services being provided. W1 stated R1 was not given the proper notification for the increase of fees. W1 also stated that R1 was responsible for signing her own paperwork. S1 stated during interview that R1 wanted to pay more money to the facility because of the incontinent products and R1’s cat. S1 also said the facility never received any additional money for any fees, and it was only a conversation.

Based upon the interviews conducted and the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and a copy of report was given.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3