<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011400072
Report Date: 08/28/2023
Date Signed: 08/28/2023 01:48:35 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
03/09/2023 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230309092557
FACILITY NAME:BONITA HOUSE, INCFACILITY NUMBER:
011400072
ADMINISTRATOR:RICK CRISPINOFACILITY TYPE:
772
ADDRESS:1410 BONITA AVENUETELEPHONE:
(510) 526-4765
CITY:BERKELEYSTATE: CAZIP CODE:
94709
CAPACITY:15CENSUS: 2DATE:
08/28/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Stefanie Kral, Program DirectorTIME COMPLETED:
02:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Uncleared staff are working at facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/28/23 at 09:30 AM, Licensing Program Analysts (LPA) L. Holmes arrived unannounced to investigate the above allegation and deliver the finding. LPA was greeted by Staff #9 (S9) and Stephanie Kral, Program Director (PD) arrived about ten (10) minutes later.

SUBSTANTIATED:
Allegation: Uncleared staff are working at facility.

On 03/13/23 at around 03:30 PM, LPA, ED and CCL staff support reviewed Guardian and confirmed that the following facility Staff (S3, S4, S5, S6) did not have criminal record clearance and were “In Process” in Guardian.

Continued on LIC9099C...




Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023
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 5
Control Number 15-AS-20230309092557
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: BONITA HOUSE, INC
FACILITY NUMBER: 011400072
VISIT DATE: 08/28/2023
NARRATIVE
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 LIC9099

Based on LPA’s interviews conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D.

Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided to ED.


SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20230309092557
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: BONITA HOUSE, INC
FACILITY NUMBER: 011400072
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/28/2023
Section Cited
CCR
81019(e)
1
2
3
4
5
6
7
81019 Criminal Record Clearance (e) All individuals subject to a criminal record review...prior to working, residing or volunteering in a licensed facility:
-This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Care staff were relieved of duties and escorted from the facility on 03/13/23. Licensee to work in conjunction with CCL to confirm all care staff have criminal background clearances prior to employment.
8
9
10
11
12
13
14
Based on observation, interviews and record review, the licensee did not comply with the section cited above by 4 persons, the Care Staff, not being associated to the facility and did not have criminal record clearance which posed an immediate health, safety or personal rights risk to persons in care.

8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
03/09/2023 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230309092557

FACILITY NAME:BONITA HOUSE, INCFACILITY NUMBER:
011400072
ADMINISTRATOR:RICK CRISPINOFACILITY TYPE:
772
ADDRESS:1410 BONITA AVENUETELEPHONE:
(510) 526-4765
CITY:BERKELEYSTATE: CAZIP CODE:
94709
CAPACITY:15CENSUS: 2DATE:
08/28/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Stefanie Kral, Program DirectorTIME COMPLETED:
02:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff falsified information about clients.
Faucets used by clients for personal care do not deliver hot water.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/28/23 at 09:30 AM, Licensing Program Analysts (LPA) L. Holmes arrived unannounced to investigate the above allegations and deliver the findings. LPA was greeted by Staff #9 (S9) and Stephanie Kral, Program Director (PD) arrived about ten (10) minutes later.

UNSUBSTANTIATED:
Facility staff falsified information about clients.
Faucets used by clients for personal care do not deliver hot water.

During the investigation, LPA and CCL Staff Support reviewed Guardian and requested the following documents from Staff (S1, S2, S9, S10): Client Roster, UIR's, Pre-appraisal reports, progress notes and/or assessments, ID/Emergency information, and personal cellular numbers; documents to include January, February and March 2023 for six (6) Clients.

Continued on LIC9099C...










Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023
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 5
Control Number 15-AS-20230309092557
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: BONITA HOUSE, INC
FACILITY NUMBER: 011400072
VISIT DATE: 08/28/2023
NARRATIVE
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 LIC9099

The following documents were requested of six (6) Staff files to include training records and personnel reports with contact information. LPA toured the facility including, but not limited to the common areas, kitchen, bathroom, and office. Clients (C1, C2, C3, C4, C5, C6,) were at day program, in the community and did not return LPA's phone calls, C8 was in the community with his/her counselor, and C7 was available to interview.

For the above allegations, LPA interviewed S1, S2, S9. S10, S11 & C7, reviewed records and files for six (6) Clients and six (6) Staff for January, February, and March 2023. The following documents requested were current, including training records, personnel reports, and contact information. The records did not appear to have any discrepancies or falsifications. As far as C7 knows, C7's records are accurate. S9 & S10 confirmed that there are only two (2) new Clients at this time. S9, S10, & S11 are not aware of any documents being falsified. S9 stated that the facility's cooperate office recently sent a memo advising that there had been an alert regarding criminal background clearances, and S11 states that the Staff just documents what they are suppose to.

On 03/13/23 at around 02:35 PM, LPA and S1 toured and inspected the facility including but not limited to the common areas, kitchen, bathroom, and office; LPA tested the hot water temperature in the Clients shared bathroom at 114.6 degrees Fahrenheit (F). S1, S2, S9. S10, S11 & C7 stated that they did not have any issues with the water temperature.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview, a copy of this report, and appeal rights provided to PD.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5