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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201353
Report Date: 11/06/2025
Date Signed: 11/06/2025 02:15:03 PM

Substantiated


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
07/25/2025 and conducted by Evaluator Carol Fowler
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250725130825
FACILITY NAME:YVONNE'S HOME CARE SERVICESFACILITY NUMBER:
079201353
ADMINISTRATOR:DANIELS, CAROLYNFACILITY TYPE:
740
ADDRESS:2856 SHANE DRIVETELEPHONE:
(510) 964-4600
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY:6CENSUS: 6DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jahi Spears, Care StaffTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Staff do not treat residents with respect
Facility is malodorous
Staff do not ensure residents hygiene needs are met
INVESTIGATION FINDINGS:
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On 11/06/2025 at 1:15PM, Licensing Program Analysts (LPAs) Carol Fowler David Doidge arrived unannounced to deliver complaint findings for the allegations above. Upon arrival, LPA met with Jahi Spears, Caregiver and explained to her the reason for the visit.

During the course of the investigation, the Department conducted a tour, interviewed 1 staff and 6 residents, LPA requested reviewed and received a copy of: LIC500 (Personnel report), facility roster, and one admission agreement. Administrator emailed a copy of the house rules.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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 7
Control Number 15-AS-20250725130825
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: YVONNE'S HOME CARE SERVICES
FACILITY NUMBER: 079201353
VISIT DATE: 11/06/2025
NARRATIVE
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CONTINUE OF LIC9099

Allegation: Staff do not treat residents with respect
Investigation Finding: Substantiated

Witness 1 reported that the facility staff doesn’t treat the clients with respect. During the investigation, while conducting a tour of the facility, the LPA observed staff speaking to a client in a disrespectful manner. Interviews with clients revealed that staff had, on occasion, used inappropriate language (cursing), spoken disrespectfully to clients, and displayed negative attitudes towards clients. Additionally, it was reported that some staff members raised their voices and became visibly upset instead of maintaining a calm and professional attitude towards clients. Therefore, this allegation is Substantiated.

Allegation: Facility is malodorous


Investigation Finding: Substantiated

Witness 1 reported that the facility is malodorous. During the investigation LPA toured the facility and confirmed the presence of a malodorous smell. Staff interviews revealed that the facility is aware of the issue and working to address it. Staff also reported that the odor my be caused by clients saving cigarette butts or not maintaining proper personal hygiene. Client interviews indicated that staff often attribute the odor to clients hygiene habits. Some clients reported that the smell also originates from the bathroom area, as certain clients have been using the floor instead of the toilet, clients also stated that it’s a house with 6 guys and the place is not expected to smell the best. Therefore, this allegation is Substantiated.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 15-AS-20250725130825
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: YVONNE'S HOME CARE SERVICES
FACILITY NUMBER: 079201353
VISIT DATE: 11/06/2025
NARRATIVE
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CONTINUE FROM LIC9099

Allegation: Staff do not ensure residents’ hygiene needs are met
Investigation Finding: Substantiated

Witness 1 reported that staff do not ensure clients’ hygiene needs are met. During the investigation, the LPA toured the facility and observed that the supply of hygiene products was insufficient for the number of clients in care. The facility inventory included two small travel-size toothpastes, six bars of soap, and no shampoo, lotion or powder. Interviews with staff confirmed that the facility has limited hygiene supplies available. Staff also reported that clients buy their own hygiene supplies. Interview with clients confirmed and further supported that hygiene products are not consistently provided by the facility. Therefore, this allegation is Substantiated.


Based on the Department’s investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D.

Exit interview conducted. A copy of this report and appeal rights provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
07/25/2025 and conducted by Evaluator Carol Fowler
COMPLAINT CONTROL NUMBER: 15-AS-20250725130825

FACILITY NAME:YVONNE'S HOME CARE SERVICESFACILITY NUMBER:
079201353
ADMINISTRATOR:DANIELS, CAROLYNFACILITY TYPE:
740
ADDRESS:2856 SHANE DRIVETELEPHONE:
(510) 964-4600
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY:6CENSUS: 6DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jahi Spears, Care StaffTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure the residents’ clothes are clean
INVESTIGATION FINDINGS:
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On 11/06/2025 at 2:00PM, Licensing Program Analysts (LPAs) Carol Fowler and David Doidge arrived unannounced to deliver complaint findings for the allegation above. Upon arrival, LPA met with Jahi Spears, Care Staff and explained to her the reason for the visit.

During the course of the investigation, the Department conducted a tour, interviewed 1 staff and 6 residents, LPA requested reviewed and received a copy of: LIC500 (Personnel report), facility roster, and one admission agreement. Administrator emailed a copy of the house rules.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 15-AS-20250725130825
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: YVONNE'S HOME CARE SERVICES
FACILITY NUMBER: 079201353
VISIT DATE: 11/06/2025
NARRATIVE
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CONTINUE FROM LIC9099A

Allegation: Staff do not ensure the residents’ clothes are clean
Investigation Finding: unsubstantiated

Witness 1 reported that the facility is not ensuring that clients’ clothes are clean. LPA toured the facility and witnessed where the laundry is washed. Interview with staff revealed that the clients wash their clothes two to three times a week. Interview with clients revealed that the clients wash their clothes about 3 times a week. Therefore, this allegation is Unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff did not give medications as prescribed is unsubstantiated.

No deficiencies observed during visit.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 15-AS-20250725130825
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: YVONNE'S HOME CARE SERVICES
FACILITY NUMBER: 079201353
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2025
Section Cited
CCR
87468.1
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(a) Residents in all residential care facilities for the...l of the following personal rights:
(1) To be accorded dignity in their personal... staff, residents, and other persons.
This requirement was not met as evidence by:
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Administrator agreed to have staff training on personal rights/anger management with a CCLD approved vendor,
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Based on interviews and observation, the Licensee did not comply with the section cited above by not speaking to residents with dignity and respect which poses a potential health and safety risk to persons in care.
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submit proof of training for each staff including Administrator to the Department by the POC date.
Type B
11/28/2025
Section Cited
CCR
87303(a)(b)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times. (b) Maintenance shall include provision of maintenance ... the safety and well-being of residents, employees and visitors.
This requirement was not met as evidence by:
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Administrator agreed to have the entire facility deep cleaned, including but limited to carpets, floors, windowsills, curtains cleaned or replaced, and spiderwebs removed.
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Based on observation, the Licensee did not comply with the section above by not keeping facility clean, safe, sanitary, and odor free which poses a potential health and safety risk to persons in care.
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 The administrator also agreed to have all staff trained on buildings and grounds keeping the facility clean, safe, sanitary and odor free by a CCLD approved vendor and submit proof of training to the Department by the POC date.
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: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 15-AS-20250725130825
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: YVONNE'S HOME CARE SERVICES
FACILITY NUMBER: 079201353
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2025
Section Cited
CCR
87307(D)
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(D) Hygiene items of general use such as soap and toilet paper.
This requirement was not met as evidence by:
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Administrator agreed to purchase hygiene supplies and provide proof of purchase and pictures of supplies to the Department by the POC date.
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Based on interview and observation, the Licensee did not comply with the section above by not having sufficient amount of hygiene supplies for the number of residents in the facility, which poses a potential health and safety risk to persons in care.
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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: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7