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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011440756
Report Date: 04/17/2023
Date Signed: 04/17/2023 02:07:27 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
02/17/2023 and conducted by Evaluator Gregory Clark
COMPLAINT CONTROL NUMBER: 15-AS-20230217120915
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:
04/17/2023
UNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Bobbie French, LicenseeTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff did not ensure facility was free from pest resulting in resident sustaining injury
Facility plumbing in disrepair
INVESTIGATION FINDINGS:
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On 4/17/23 at 1:55 p.m. Licensing Program Analyst (LPA) Greg Clark conducted an unannounced visit to deliver findings for the above allegations. LPA met with Bobbie French, Licensee and explained the purpose of the visit.

During the course of investigation, LPA toured the facility, obtained information, interviewed the reporting party, one staff and 2 residents.

Regarding the allegation the staff did not ensure facility was free from pest resulting in resident sustaining injury. Based on interviews conducted on 2/23/23 and 4/10/23 and observation performed on 2/23/23 this allegation is unsubstaniated. 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.

Continued on LIC9099C






Facility plumbing in disrepair
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
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 2
Control Number 15-AS-20230217120915
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: 04/17/2023
NARRATIVE
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Report continues from LIC9099

Regarding the allegation that facility plumbing in disrepair. On 2/23/23 LPA observed a toilet in the bathroom of the facility by the bedrooms that was in working order. Based on observation performed on 2/23/23 this allegation is 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.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2