011401135-1-6-2023-15-AS-HHUL-CNFNXS-20230126095138

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 011401135
Report Date: 01/06/2023
Date Signed: 01/06/2023 12:11:43 PM

Unsubstantiated

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
04/13/2021 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20210413104556

FACILITY NAME:	CLAUSEN HOUSE		FACILITY NUMBER:	011401135
ADMINISTRATOR:	STACIA OLIVIER		FACILITY TYPE:	735
ADDRESS:	363 BELMONT ST		TELEPHONE:	(510) 763-3598
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94610
CAPACITY:	11	CENSUS: 5	DATE:	01/06/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Veronica Santana, Administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff is not safeguarding residents personal belongings
Staff are allowing residents to call resident names
Staff threatened resident
Client locked out of facility

INVESTIGATION FINDINGS:

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On 1/06/23 at 11:30 AM, Licensing Program Analyst (LPA) G. Clark arrived unannounced to deliver findings for the above allegations. LPA met with Veronica Santana, Administrator and explained the purpose of the visit.

During the course of the investigation, LPA L. Francisco obtained information, reviewed records, collected documents, interviewed staff and clients. It was alleged staff is not safeguarding residents personal belongings. Based on information obtained by complainant, snacks and food that are purchased by clients are being taken by other clients. However, interview with S1 revealed that clients have the option to request for staff to store personal food items in the pantry downstairs. S1 stated that clients are also encouraged to label personal items with their names. 2 of 2 clients denied allegation.

***report continues on LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20210413104556

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: CLAUSEN HOUSE	FACILITY NUMBER: 011401135
	VISIT DATE: 01/06/2023

NARRATIVE

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***report continues from LIC9099***

It was alleged staff are allowing residents to call resident names. However, interview with 2 of 2 staff revealed that staff intervenes and separate clients during altercations. 2 of 2 clients denied allegation and 1 of 2 client stated that clients are separated by staff if clients are speaking to each other inappropriately.

It was alleged staff threatened resident, however 2 of 2 staff denied threatening clients. S1 stated that C1 threatens other clients and staff. 2 of 2 clients denied being threatened by staff.

It was alleged client locked out of facility. Based on information obtained, C1 was banging on the door, but staff did not answer. LPA obtained a call history showing that C1 called facility at 12:38 AM. However, the phone number indicated on the call log is not the facility phone number. S1 said staff did not hear anyone knocking on the door nor observed client’s phone number on the facility phone’s call log. According to S1, clients were instructed to enter from the back door of the facility. LPA interviewed 2 clients and 2 of 2 stated they have not been locked out of the facility nor heard of a client being locked out.

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

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

LIC9099 (FAS) - (06/04)

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