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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011440756
Report Date: 03/23/2023
Date Signed: 03/23/2023 10:35:22 AM

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
03/14/2023 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20230314123941
FACILITY NAME:BOBBI FRENCH RESIDENTIAL CARE FACILITYFACILITY NUMBER:
011440756
ADMINISTRATOR:GOOLSBY, NORMANFACILITY TYPE:
735
ADDRESS:521 - 32ND STREETTELEPHONE:
(510) 428-9424
CITY:OAKLANDSTATE: CAZIP CODE:
94609
CAPACITY:6CENSUS: 3DATE:
03/23/2023
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Bobbi French, Licensee TIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff do not ensure the facility has a working telephone number
INVESTIGATION FINDINGS:
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On 03/23/2023 starting at 09:10 am, Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct complaint investigation for the above allegation. LPA met with Licensee, Bobbi French and explained the purpose of the visit.

During the course of investigation, LPA obtained information and interviewed one staff and one residents.
On the allegation facility staff do not ensure the facility has a working telephone number. Based on observation the facility only has one phone for both the private residence and the facility. LPA called the phone while in the facility and was unable to hear it ringing.

Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
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 4
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
03/14/2023 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20230314123941

FACILITY NAME:BOBBI FRENCH RESIDENTIAL CARE FACILITYFACILITY NUMBER:
011440756
ADMINISTRATOR:GOOLSBY, NORMANFACILITY TYPE:
735
ADDRESS:521 - 32ND STREETTELEPHONE:
(510) 428-9424
CITY:OAKLANDSTATE: CAZIP CODE:
94609
CAPACITY:6CENSUS: 3DATE:
03/23/2023
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Bobbi French, Licensee TIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff do not allow authorized representatives access to the facility
INVESTIGATION FINDINGS:
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On 03/23/2023 starting at 09:10 am, Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct complaint investigation for the above allegation. LPA met with Licensee, Bobbi French and explained the purpose of the visit.

During the course of investigation, LPA obtained information, collected documents and interviewed one staff and one residents. Based on interviews the facility does allow visitors of all types to come to the facility and the reidents invite who they want over.

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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 15-AS-20230314123941
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: BOBBI FRENCH RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 011440756
VISIT DATE: 03/23/2023
NARRATIVE
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Continued from LIC9099.

Based on LPA’s interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 has been cited.

Exit interview conducted. A copy appeal rights, and this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20230314123941
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: BOBBI FRENCH RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 011440756
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/06/2023
Section Cited
CCR
85072(b)(9)
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To have access to telephones in order to make and receive confidential calls, provided that such calls do not infringe upon the rights of other clients and do not restrict availability of the telephone during emergencies.
This requirement was not met as evidenced by:
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The licensee will purchase additional phones for the facility. Proof of correction will be sent to CCLD by POC date.
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Based on interview the licensee did not comply with the section cited above by having one phone that was inaccessible to the residents that was located on the private resident side.
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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.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4