011401330-4-12-2022-15-AS-KHOS-CE6HFN-20220506060951

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 011401330
Report Date: 04/12/2022
Date Signed: 04/12/2022 11:38:48 AM

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
08/06/2020 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20200806114548

FACILITY NAME:	CLAUSEN HOUSE		FACILITY NUMBER:	011401330
ADMINISTRATOR:	BARBARA LANG		FACILITY TYPE:	735
ADDRESS:	201 PERKINS STREET		TELEPHONE:	(510) 839-0050
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94610
CAPACITY:	11	CENSUS: 7	DATE:	04/12/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Veronica Santana, Senior Program Director		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff stole client's money while in care.

Staff mishandled and beat client while in care.

Staff spit at client.

INVESTIGATION FINDINGS:

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On 4/12/2022 at 10:30AM, Licensing Program Analysts (LPA), L. Hall and L. Fici arrived unannounced to conduct a complaint investigation and deliver complaint findings for the allegations above. LPA met with Veronica Santana, Senior Program Director and explained the reason for the visit.

During the investigation LPA G. Luk interviewed clients, staff, and CM. LPAs collected facility and staff roster. Interview with CM stated that RCEB became C1’s payee in February 2020. CM also stated that C1’s family member had access to his finances previously and C1 had given family member authorization to take a certain amount of money. The family member attempted to get C1’s paycheck with a POA letter, that was later eliminated by CM. Interview with S1 indicated that there had not been any incidents of clients losing money.
Continued on LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

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-20200806114548

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: 011401330
	VISIT DATE: 04/12/2022

NARRATIVE

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Continued from LIC9099.

On the allegation staff mishandled and beat client while in care. During today's visit C1 was not available for interview. LPAs interviewed C2. C2 is a long time resident. C2 stated that the staff are very nice to the clients. Staff does not yell or any mistreat clients.

On the allegation staff spit at client. During interview with CM it was stated that CM had a meeting with C1, S1, and day program administrator. During the meeting C1 stated someone laid hands on him but was not able to name a specific person. C1 never stated that someone spit on him.

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: Laura Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

LIC9099 (FAS) - (06/04)

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