Lakeshore Residential Care

On 04/15/2026 at 4:17PM, Licensing Program Analyst (LPA) Carol Fowler was at the facility for a complaint investigation (#15-AS-20260406090956), the following deficiencies were observed. During the complaint investigation, LPA observed the following: *Medication room unlocked which contained medication such as Benadryl. *Pre-poured medication. *Unlocked chemical. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. Exit interview conducted. A copy of this report, and appeal rights provided.

While at the facility to deliver findings on a complaint investigation, Licensing Program Analyst (LPA) Catherine Lin conducted a case management to address concerns noted while investigating on the facility’s handling of residents’ cash resources. Deficiencies and plans of correction were discussed with Administrator, and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview was conducted and Appeal Rights was provided to Administrator.

On 12/30/20 Licensing Program Analyst (LPA) G. Clark and LPM Yvonne Flores-Larios arrived unannounced to conduct Infection Control Inspection. LPA and LPM met with Administrator, Gaffar Syed and explained the purpose of the visit. During the Infection Control Inspection, LPA and Lpm toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and backyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. Updated visitors policy will be posted on the front entrance. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. LPA and LPM advised that more signs should be throughout the facility. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. Covered trash cans are needed in all shared bathrooms and beds need to be 6 feet apart. Facility has a mitigation plan and maintains record of routine screening for residents and staff. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

LPA interviewed S1 at the facility. S1 identified the individual in question as R1 and was well aware of R1's complaint. R1 does attend the program where W1 works and often complains about not getting enough medication. S1 stated that R1 is on a controlled medication so the facility must take extra steps to safeguard it. LPA reviewed medication administration records and compared them with the bubble packed medication. LPA found no discrepancies. LPA interviewed R1 via phone as he was at his program. R1 said he liked living at the facility. LPA asked about his medication and R1 replied “they don’t give me enough.” This agency has investigated the above complaint. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is 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.

***CONTINUE FROM 9099** LPAs interviewed R2 who stated that did not hit R1 and that he never hits anyone stating "I don't want to get in trouble." R2 stated that he approached R1 and asked her to quiet down or leave the patio as he was " trying to meditate". LPAs interviewed S1 who stated that on 5/23/25 R1 was observed sitting in the patio area talking very loudly on her cellphone when another resident (R2) and asked R1 to quiet down. R1 then yelled out that R2 had hit her and then R1 called Oakland Police Department (OPD). S1 did not see R2 hit R1. S1 further stated that OPD arrived, interviewed both parties and issued citations to each of them. S1 also stated that R1 called 911 and went to the hospital to be checked out. LPAs reviewed the discharge papers from the hospital visit that documented there was no injuries to R1's face. During the course of the visit LPAs observed the facility residents to be quiet and respectful to each other space. S1 stated the facility is very mindful of not accepting residents who have a history of aggressive behavior as many of the residents in the facility are very vulnerable. On 7/10/25 LPA asked R1 about another incident that allegedly happened on 4/27/25 when R1 was allegedly attacked by R3. R1 could not recall the incident and didn't want to about it anymore. S1 said he did not recall any incident between R1 and R3 and that R3's room is on the opposite side of the facility from R1's room and it's not likely that the two had any interaction. This agency has investigated the complaint alleging staff did not prevent resident on resident assault . We have found that the complaint was unsubstantiated. Although the allegation may have happened or is 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.

Allegation: staff do not follow residents care plan LPA reviewed R1, R2, R3 and R4’s care plans. LPA also interviewed R1, R2, R3 and R4. LPA asked about the care they are receiving at the facility and all 4 residents confirmed that they are receiving the care that is outlined in their care plans. This allegation is unsubstantiated. Allegation: staff do not allow resident to receive visitors Interview with S1 and S2 revealed that R1 was allowing visitors to come back to her bedroom without the facility staff even knowing that the visitors were in the building. R1 was using her cell phone to contact her visitors. On one occasion one of the visitors, a male, was seen lying on R1’s bed. The facility’s visitation policy states that visitors must wait in the lobby for staff to get the residents they wish to visit and the visit should take place in one of the common areas of the facility. Since all of the rooms are shared this policy ensures that the right to privacy of the roommate is protected. LPA also reviewed the visitation policy in the facility’s admission agreement, and it states that visitors should “wait in the lobby for staff assistance when visiting residents.” This allegation is unsubstantiated. Allegation: staff do not maintain facility is kept clean and free of odors LPA has been at this location on numerous occasions over the past three years. LPA has always observed the housekeeping staff to be very attentive and preforming their tasks to ensure the facility is clean and free of orders. LPA has never observed the facility to be dirty or smelly. S1 stated that they have 3 full-time housekeepers on duty from 7:00 AM to 7:00 PM. It should be noted that many of the residents are incontinent and sometimes have incontinence in the common areas of the facility. It is the experience of the LPA that staff are quick to clean up the mess. This allegation is unsubstantiated. Allegation staff do not provide resident with housekeeping service As stated above the facility has three full time housekeepers. During numerous visits to the facility LPA has observed the housekeepers preforming their work, i.e. sweeping, and mopping the floors, dusting surfaces, emptying trash cans, cleaning the residents' rooms, etc. They rotate throughout the facility to ensure the facility is kept clean. Residents’ bathrooms are cleaned on a rotating schedule. This allegation is unsubstantiated. ***report continues on LIC9099C*** 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ***report continues from LIC9099C*** Allegation: staff do not provide resident with toilet paper LPA observed toilet paper in R1's bedroom and bathroom as well as in her locked closet. LPA also observed toilet paper in several of the other bathrooms at the facility. S1 and S2 also stated they tell staff to check for toilet paper when they are working with the residents. This allegation unsubstantiated. Allegation: staff do not provide residents with activities LPA reviewed the facilities activity schedule and observed that there were several activities each day for the residents to participate in. LPA also observed that the activities occurring match what is listed on the activity schedule. During LPA's interview with R1 she stated that she doesn't like to participate in the activities at the facility because she doesn't like interacting with the other residents. R1 prefers to stay in her room and read, exercise and journal. This allegation is unsubstantiated. This agency has investigated the allegations above. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is 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.

Allegation: Staff did not seek medical attention for resident (R1) in a timely manner. The reporting party stated that R1 sustained laceration to the forehead, and it was still bleeding when Emergency Medical Team (EMT) arrived. RP further stated that R1 had fallen at 8:30am and the facility was delayed in seeking medical attention when R1 had bleeding. W1 stated that W1 came to the facility in the afternoon to attend to R1 who was bleeding when W1 arrived. W1 had to wrap R1’s head to control the bleeding. W1 further stated that the facility called the ambulance when it should be 9-11 that they should call, because R1 fell and was bleeding. LPA reviewed R1’s UIR which showed R1 fell at 8:15 am, was bleeding in the forehead and first aid performed. UIR also confirmed W1’s statement that ambulance was called at 3:00 pm. When LPA interviewed R1, R1 verbalized he was in pain. Based on interviews and records review, the allegation is substantiated. Allegation: Facility has pests. Two out of 3 staff and 2 out of 3 residents interviewed stated observing cockroaches. W1 also stated observing cockroaches in R1’s room. Therefore, the allegation is substantiated. Based on interviews which were conducted, the preponderance of evidence has been met, therefore the above allegations are substantiated. Deficiencies are cited from Title 22 California Code of Regulations and listed on 9099D . Failure to submit proof of correction by plan of correction due date and any repeat violation within 12-month period may result in civil penalty. Deficiencies and plan and proof of corrections were discussed with ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation: Resident (R1) had an incident while in care. Allegation: Resident (R1) sustained injury while in care. LPA interviewed R1 who was able to verbalized he was pain but unable to provide other information. R2, R3, R4 stated staff are okay. One of the staff interviewed stated not observing other staff being abusive or hurt any of the residents. Review of UIR showed R1 fell on 2/08/22 at the kitchen door in the hallway and sustained injury in the forehead. One of the 3 staff interviewed stated R1 fell near the kitchen. Review of R1’s LIC602A showed that although R1 has dementia but ambulatory. LIC625 did not indicate R1 needed assistance in ambulation. Based on interviews and record review and LPA unable to obtain information from R1 about the incident, the allegations are unsubstantiated. An unsubstantiated findings means that although the allegations may have happened or are valid, the preponderance of evidence standard has not been met. No deficiency cited. Exit interview conducted and copy of this report provided.

On 7/10/25 at 3:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver amended report for complaint #15-AS-20250528164448. LPA spoke with Administrator Gaffar Syed who gave permission for care staff to sign the report. Amended report delivered to staff. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

Allegation: staff do not ensure resident’s shower is in good repair. LPA toured the shower room with S1. LPA observed that there are three separate shower heads in the shower room. All three were in operating condition during the visit. R1 has a staff assisted shower. LPA interviewed S2 who assists R1 with her showers. S2 confirmed that there was issue with the shower hose being twisted which caused the water to stop flowing momentarily. S2 untwisted the hose and continued with the shower. This agency has investigated the complaint alleging staff do not accord resident privacy and staff do not ensure resident’s shower is in good repair. We have found that the complaints were unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview conducted, a copy of this report provided.

On 6/10/24 R1 became argumentative with another resident (R3) wanting to take her snack. Staff intervened and R1 was redirected. However, another resident (R2) called 911, police arrived and R1 was taken to Summit Hospital and subsequently transferred to John George Psychiatric Hospital where he remains as of today. Doctors at John George are adjusting R1’s medications to lessen his anxiety and combativeness. S1 stated that the residents at the facility were never in any danger due to R1’s behaviors and that staff took appropriate action to redirect R1 to ensure the safety of the other residents. LPAs interviewed R2. R2 stated that she feared for the safety of the other residents and was unaware that staff were redirecting R1 to unsure the safety of the other residents. R2 also stated that she felt R1 was a “bad person” and should be living at the facility. LPAs interviewed R3. R3 stated that she was “very happy” living at the facility and that she has several friends whom she likes to socialize with. LPAs asked R3 about the incident involving R1 but R3 could not recall the incident. R3 also stated that she felt safe living at the facility. LPAs also interviewed S2. S2 stated that while attempting to give R1 his PM medications (S2 couldn’t recall the date) R1 grabbed the medications from her and threw them on the floor. He also grabbed the water cup and threw that as well. R1 also scratched S2 on her face. S2 declined medical attention. S2 also stated that feels “very safe” working at the facility. This agency has investigated the complaint alleging staff do not ensure a safe environment is provided for residents. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is 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.

On 12/17/24 at 1:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Gaffar Syed, Administrator and explained the purpose of the visit. LPA toured the facility including but not limited to bedrooms, bathrooms, activity room, kitchen, common area and courtyard. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 70 degrees F. The hot water temperature in the kitchen was measured at 115.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 10/29/24 Emergency Disaster Plan was last posted on 12/13/24. First aid kit was observed to be complete. LPA reviewed 5 residents records and 5 staff records, and all were complete. LPA also reviewed a sample of resident’s medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 12/14/23 Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Gaffar Syed, Administrator and explained the purpose of the visit. The facility’s fire clearance was approved for 38. LPA toured the facility including but not limited to bedrooms, bathrooms, activity room, kitchen and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 70 degrees F. The hot water temperature in a residents’ shared bathroom was measured at 117.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 10/10/23. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 9/29/23. LPA reviewed 5 residents records and 5 staff records, all were complete. LPA also reviewed a sample of resident’s medications. During the visit LPA received an updated LIC610E Emergency and Disaster Plan and LIC9282 Infection Control Plan. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

The RP stated that she asked the facility to take R1 back until a SNF placement could be found. S1 told the RP that they could not take R1 back because her level of care is outside the scope of their license. This agency has investigated the complaint alleging staff did not allow resident back to the facility. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is 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.

Although the allegation may have happened or is 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 reported provided.

**report continues*** This agency has investigated the complaint. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is 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 reported provided.

On 3/3/2026, at 11:35am, Licensing Program Analyst (LPA), L. Hall arrived unannounced conduct a case management health and safety check. LPA met with Gaffar Syed, Administrator, and explained the reason for the visit. During the health and safety check, LPA toured the facility including but not limited to common areas, kitchen, bathrooms, bedrooms and outdoor common area. LPA observed servers passing dinner to residents. Resident were in the common area, hallways, and bedrooms. The facility is noted to be clean, in good repair, and residents in care appear to be safe. There is a minimum of 7-day non-perishables and 2-day perishables foods. There are no imminent health concerns on today's date. LPA observed the following deficiency during visit: At 3:25pm, LPA observed front entry door was locked from inside. A key had to be used to open door. Continued on LIC809C. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from LIC809. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights and this report provided.

On 12/14/22 at 2:40 p,m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct Infection Control Inspection. LPA met with Administrator, Gaffar Syed and explained the purpose of the visit. During the Infection Control Inspection, LPA toured facility including but not limited to: front entrance, screening station, bathrooms, bedrooms, common areas, kitchen and backyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. Visitors policy is posted on the front entrance. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPE maintained at central location and easily accessible for staff. Facility has a mitigation plan and maintains record of routine screening for residents and staff. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

Allegation: Resident is without toiletries. During the interview, R1 states that facility provides soap, shampoo, toilet paper and other hygiene products. Administrator and staff state that the facility provides all residents with hygiene products and toiletries all the time. This allegation is unsubstantiated. Allegation: Staff requesting money from resident. LPA L. Fontanilla interviewed R1 on 4/20/21. During the interview, LPA asked R1 if there is a staff asking money from R1. R1 states there is a staff who asks money but R1 does not know the name because staff use fake name. Administrator states that facility is handling R1’s money as requested by R1. Administrator added that facility maintains a log for R1’s expenses. Administrator provided LPA a copy of R1’s expenses log. Staff interviewed denied knowing any staff asking money from R1 or any other resident. This allegation is unsubstantiated. Based on interviews and records review conducted, the allegations are UNSUBSTANTIATED, meaning that although the allegations may have happened or are valid, there are not a preponderance of the evidence to prove that violations occurred. Exit interview was conducted and copy of this report provided to Administrator.