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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201565
Report Date: 04/23/2026
Date Signed: 04/23/2026 04:13:05 PM

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
11/03/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20251103161046
FACILITY NAME:ECOLUX ASSISTED LIVINGFACILITY NUMBER:
079201565
ADMINISTRATOR:VERMA, BHARATFACILITY TYPE:
740
ADDRESS:200 EAGLE NEST DRTELEPHONE:
(650) 665-0894
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:6CENSUS: 5DATE:
04/23/2026
UNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:Ronald Doca, Caregiver TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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cility staff are not following residents care plan
INVESTIGATION FINDINGS:
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On 04/23/2026 at 1:04PM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to deliver complaint findings for the allegations above. LPA met with Donald Doca, caregiver, and explained the reason for the visit. Bharat Verma, Administrator arrive at 1:47PM, LPA explained the purpose of visit.

During the investigation, LPA interviewed witness (W1) and staff (S1). LPA also reviewed and obtained the following documents: Facility and staff roster, resident (R1’s) appraisal, appraisal needs and service plan, MAR, ID and Emergency, admission agreement, physician report, care plan, care notes, hospice care notes dated 10/13/2025-11/01/2025, facility care notes dated 10/13/2025-11/01/2025, facility daily caregiver checklist, staff contact information and staff training records (2025).

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 6
Control Number 15-AS-20251103161046
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: ECOLUX ASSISTED LIVING
FACILITY NUMBER: 079201565
VISIT DATE: 04/23/2026
NARRATIVE
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Continued from LIC9099


Facility staff are not following residents care plan

Interview with S1 revealed facility is following care plan from hospice agency. Record review revealed, hospice care plan stated medication is to be administered twice a day at 7:00am and 7:00pm, facility care plan revealed facility is administering medication twice a day at 7:00am and 3:00pm.

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 6
Control Number 15-AS-20251103161046
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: ECOLUX ASSISTED LIVING
FACILITY NUMBER: 079201565
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/24/2026
Section Cited
CCR
87633(d)
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(d) The licensee shall ensure that the hospice care plan is current, accurately matches the services actually being provided, and that the client’s care needs are being met at all times. This requirement is not met as evidenced by:
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By POC date. Licensee has agreed to read regulation 87633 and implement a plan regarding following hospice care plan for residents in care and send email of plan to CCLD.
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Based on record review, the licensee did not comply with the section cited above by not following R1’s hospice plan regarding medications which posed an immediate 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.
SUPERVISOR'S 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 6
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
11/03/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20251103161046

FACILITY NAME:ECOLUX ASSISTED LIVINGFACILITY NUMBER:
079201565
ADMINISTRATOR:VERMA, BHARATFACILITY TYPE:
740
ADDRESS:200 EAGLE NEST DRTELEPHONE:
(650) 665-0894
CITY:OAKLEYSTATE:CAZIP CODE:
94561
CAPACITY:6CENSUS: 5DATE:
04/23/2026
UNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:Ronald Doca, Caregiver TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility is unsanitary
Staff not properly trained.
Staff performed inappropriate restraint on resident
Facility staff are not providing water to residents in care
Facility has locked resident in room
Facility staff are not assisting resident with personal hygiene
Facility staff are not assisting residents with incontinence care
Personal rights- resident is not treated with dignity
INVESTIGATION FINDINGS:
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On 04/23/2026 at 1:04PM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to deliver complaint findings for the allegations above. LPA met with Donald Doca, caregiver, and explained the reason for the visit. Bharat Verma, Administrator arrive at 1:47PM, LPA explained the purpose of visit.

Facility is unsanitary
Interview with S1 revealed facility staff clean facility throughout the day. R1 suffered from behaviors such as fecal smearing, which required staff to clean 2-3xs a day in common areas and R1’s room. S1 stated staff were deep cleaning the facility as well after R1’s behaviors. Based on LPAs observation, during visits on 07/09/2025,11/17/2025 and 04/08/2026 facility was sanitized and free from odor.

Continue on LIC9099C
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 6
Control Number 15-AS-20251103161046
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: ECOLUX ASSISTED LIVING
FACILITY NUMBER: 079201565
VISIT DATE: 04/23/2026
NARRATIVE
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Continued from LIC9099

Staff not properly trained.

Interview with S1 revealed that all staff are fully trained and maintain current certifications, for the required training by law such as dementia care, infection control, and medication training. In addition, S1 provides ongoing trainings on dementia behavior management, communication techniques, and personal care. Record review revealed staff have certificates of completion of trainings which meets the training requirements.

Staff performed inappropriate restraint on resident

Interview with S1 revealed at no time was R1 restrained in any form- physically or otherwise. R1 had full freedom of movement throughout the entire day, R1 often sit comfortably in his recliner chair, at the dining table during meals, or resting in his bedroom by choice. Hospice staff would observe R1 in these settings when they visit.

Facility staff are not providing water to residents in care

Interviews with S1 revealed water is given to all residents throughout the day and with each meal. Hydration reminders are part of the daily caregiver checklist. Hospice has never raised any concerns around hydration.

Facility has locked resident in room

Interview with S1 revealed that resident has locked himself in the bedroom a couple of times and staff immediately responded to unlock the door to ensure safety by using an sharp object to unlock door from the outside.

Continue on LIC9099C.....

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: 5 of 6
Control Number 15-AS-20251103161046
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: ECOLUX ASSISTED LIVING
FACILITY NUMBER: 079201565
VISIT DATE: 04/23/2026
NARRATIVE
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Continued from LIC9099C...

Facility staff are not assisting resident with personal hygiene

Interview with S1 revealed staff provided R1 with consistent personal hygiene care. R1 fecal smearing behavior required multiple cleanings daily causing staff to above and manage the issue.

Facility staff are not assisting residents with incontinence care

Interview with S1 revealed staff provided R1 with incontinent checks and changed R1 regularly throughout the day. R1’s behaviors required additional attention and more checks than the other residents in care.

Personal rights- resident is not treated with dignity

Interview with S1 revealed R1 was treated with the respect and kindness at all times. Staff do not change any residents in the living room; our residents are treated with dignity and respect, they are either changed in restroom or their bedrooms.

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: 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: 6 of 6