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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200523
Report Date: 04/23/2026
Date Signed: 04/23/2026 11:59:39 AM

Substantiated


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
12/22/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20251222101326
FACILITY NAME:BRUIZ CAREHOMEFACILITY NUMBER:
079200523
ADMINISTRATOR:BERNARDINO-RUIZ, JAMIE AFACILITY TYPE:
740
ADDRESS:2353 DEMARTINI LANETELEPHONE:
(925) 634-8802
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:6CENSUS: 6DATE:
04/23/2026
UNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Cherry Corazon, Caregiver TIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff illegally evicted a resident in care.
INVESTIGATION FINDINGS:
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On 04/23/206 at 9:48AM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to conduct an investigation and deliver complaint findings for the above allegations. LPA met with Cherry Corazon, caregiver and explained the reason for the visit. Marilou Intog, House Manager arrived at approximately 10:10AM, LPA explained the purpose of visit.


During the investigation, LPA interviewed W1, W2, S1, S2 and S3. LPA reviewed and obtained the following documents: staff roster, staff contact information, residents’ roster, resident (R1) emergency information, admission agreement, appraisal needs and service plan, physician’s report, daily behavior notes and all incidents’ reports.

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

DATE: 04/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
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 4
Control Number 15-AS-20251222101326
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: BRUIZ CAREHOME
FACILITY NUMBER: 079200523
VISIT DATE: 04/23/2026
NARRATIVE
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Continued from LIC9099


Allegation: Staff illegally evicted a resident in care.

Interview with W1 revealed, W1 called S1 to advise R1 was ready to be picked up from the hospital, S1 stated would not allow R1 back into the home, R1 needs could not be met at the facility. Interview with W2 revealed, W2 called S1 a couple of times for R1’s discharge planning, S1 informed W2 of not be taking R1 back. Interview with S1 revealed R1’s behavior was impacting the other residents at the facility and R1 was no longer a good for the facility due to behaviors. Interview with S1 also revealed, S1 refused to accept R1 back without the proper eviction notice.


Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted and a copy of this report and appeal rights were given.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20251222101326
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: BRUIZ CAREHOME
FACILITY NUMBER: 079200523
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/03/2026
Section Cited
CCR
87224(a)
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87224 Eviction Procedures
(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5)
This requirement is not met as evidenced by:
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By POC date. Administrator has agreed to review the eviction procedures and submit self-certification email to CCLD.
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Based on interviews, licensee did not comply with the section cited above by refusing to accept a R1 back without an eviction notice which poses a potential health and safety risk to the 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: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
12/22/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20251222101326

FACILITY NAME:BRUIZ CAREHOMEFACILITY NUMBER:
079200523
ADMINISTRATOR:BERNARDINO-RUIZ, JAMIE AFACILITY TYPE:
740
ADDRESS:2353 DEMARTINI LANETELEPHONE:
(925) 634-8802
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:6CENSUS: 6DATE:
04/23/2026
UNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Cherry Corazon, Caregiver TIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff caused an injury to a resident in care.
INVESTIGATION FINDINGS:
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On 04/23/206 at 9:48AM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to conduct an investigation and deliver complaint findings for the above allegations. LPA met with Cherry Corazon, caregiver and explained the reason for the visit. Marilou Intog, House Manager arrived at approximately 10:10AM, LPA explained the purpose of visit.


Allegation: Staff caused an injury to a resident in care.
Interview with W1 revealed R1 sustained a bruise on chest, W1 wasn’t sure if it was caused by contact from staff or R1. Interview with W2 revealed, W1 informed nursing staff of R1 having a bruise, W2 consulted with the doctor, doctor was positive medical reasons were the reason for bruising. Interviews with S1, S2 and S3 revealed staff did not handle R1 in a manner of causing injury.


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.

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

DATE: 04/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
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 4