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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201139
Report Date: 10/30/2025
Date Signed: 10/30/2025 03:55:18 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
09/05/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250905154824
FACILITY NAME:SIMONE SUMMIT CARE HOMEFACILITY NUMBER:
079201139
ADMINISTRATOR:MATEL, MARIA TFACILITY TYPE:
740
ADDRESS:1930 LAS COLINAS DR.TELEPHONE:
(925) 522-6145
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:6CENSUS: 1DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
01:47 PM
MET WITH:Maria Matel, AdministratorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Neglect/lack of supervision
INVESTIGATION FINDINGS:
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On 10/30/2025 at 1:47PM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to deliver complaint findings for the allegation above. LPA met with Maria Matel, Administrator, and explained the reason for the visit.

Allegation:Neglect/lack of supervision
During the investigation, LPA interviewed resident (R1), ADM and staff (S1), LPA also obtained documents. During interview with (R1), it was revealed that ADM daughter has come into R1’s room to inquire what the R1 needs when R1 presses the call button followed by staff. ADM's daughter hasn’t provided care for R1.

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

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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 2
Control Number 15-AS-20250905154824
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: SIMONE SUMMIT CARE HOME
FACILITY NUMBER: 079201139
VISIT DATE: 10/30/2025
NARRATIVE
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Continued from LIC9099


During interview with ADM, it was revealed that ADM daughter isn’t of age to be left alone and that there is always a staff member at the facility with R1. Interview with staff (S1), revealed, ADM has never left her daughter alone at facility with R1, that there have been times when staff have been in the backyard and daughter runs in R1’s room to see what R1 needs after call button is pressed and that staff is behind ADM daughter upon entering R1’s room.


Based upon 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: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2