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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201195
Report Date: 02/27/2025
Date Signed: 02/27/2025 03:19:14 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
01/31/2025 and conducted by Evaluator Gregory Clark
COMPLAINT CONTROL NUMBER: 15-AS-20250131140127
FACILITY NAME:SCARLET HOUSE FOR THE ELDERLYFACILITY NUMBER:
079201195
ADMINISTRATOR:WHITE, RACHELFACILITY TYPE:
740
ADDRESS:5111 PAUL SCARLET DRIVETELEPHONE:
(650) 580-3239
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:6CENSUS: 2DATE:
02/27/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ace White, LicenseeTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff not properly trained.
Staff did not meet the needs of the resident while in care.
INVESTIGATION FINDINGS:
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On 2/27/25 at 10:30 a.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegations above. LPA met with Ace White, Licensee and explained the purpose of the visit. At 2:00 p.m. Ace White had to leave and gave permission for care staff Jose Coronel to sign the reports.

During the course of the investigation LPA interviewed W1 and facility staff. LPA also reviewed documents related to R1.

Allegation: Staff not properly trained.
Interviews with facility staff (S1, S2, S3 and S4) revealed that all staff reported received training from the facility’s Administrator on the specifics of each of the residents’ care plans. For R1 staff stated that they received training in the proper way to transfer R1 into her shower chair and into the shower stall.

***report continues on LIC9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
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-20250131140127
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: SCARLET HOUSE FOR THE ELDERLY
FACILITY NUMBER: 079201195
VISIT DATE: 02/27/2025
NARRATIVE
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***report continues from LIC9099***

Staff further stated that for the two and half years prior to the incident on 12/05/24 they hadn’t had any issues with transferring R1 into the shower. LPA reviewed staff training records which document that staff received training on the proper way to transfer/lift residents.

Allegation: Staff did not meet the needs of the resident while in care.

LPA interviewed W1 who stated that when R1 arrived at her new facility the facility staff reported to W1 that R1 and her belongings “had an odor” and had to be washed. W1 did not witness this herself. Interviews with facility staff (S1 and S2) revealed that for the 2 years R1 lived at the facility W1 never mentioned that she felt R1’s needs were not being met or that R1 had an odor. R1 left the facility due her level of care exceeding what the facility can provide.

This agency has investigated the complaints alleging staff not properly trained and staff did not meet the needs of the resident while in care. We have found that the complaints are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
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)
Page: 2 of 2