011441025-4-6-2023-15-AS-KHOS-CR7M74-20230424092054

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 011441025
Report Date: 04/06/2023
Date Signed: 04/06/2023 02:21:49 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
11/09/2021 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20211109083238

FACILITY NAME:	ARLEEN'S RESIDENTIAL CARE #3		FACILITY NUMBER:	011441025
ADMINISTRATOR:	NICHOLAS MARCELO		FACILITY TYPE:	735
ADDRESS:	32302 CREST LANE		TELEPHONE:	(510) 477-6700
CITY:	UNION CITY	STATE: CA	ZIP CODE:	94587
CAPACITY:	6	CENSUS: 6	DATE:	04/06/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Nicholas Marcelo, Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff leave resident in his room all day and night.
Staff do not assist resident going to the bathroom.
Staff are rough with the resident.

INVESTIGATION FINDINGS:

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On 4/6/2023 at 10:00AM Licensing Program Analyst (LPA) L. Ibo conducted an unannounced complaint visit to delivered investigation findings for the above allegations. LPA met with S2; LPA explained the purpose of the visit. Administrator Nicholas Marcelo arrived after 30 mins; LPA explained the purpose of the visit.

During the course of investigation, LPA conducted records review, staff interview and clients’ interview.

Allegation: Staff leave resident in his room all day and night.

During the course of investigation, LPA conducted staff and client interview. LPA attempted to interview client (C1), however there was no available interpreter to translate LPA’s questions.

Continue to LIC9099C…

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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-20211109083238

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: ARLEEN'S RESIDENTIAL CARE #3	FACILITY NUMBER: 011441025
	VISIT DATE: 04/06/2023

NARRATIVE

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LPA conducted interview with staff, based on the interview, clients are encouraged to exercise like walking outside the facility or at the park during the daytime. There are three clients are currently attending day program and facility staff are currently working on two other clients to arrange schedule to attend day program. Based on staff interview, one client (C1), prefers to stay in his room, however the staff encouraged him to go out for a walk or to stay in the living room for couple of times in a day.

Allegation: Staff do not assist resident going to the bathroom.

During the course of investigation, LPA conducted observation, staff interview and client’s interview. LPA observed that staff were assisting client (C5) going to the bathroom at least 2x during LPA’s visit. Staff stated that three clients need assistance in the bathroom. Staff stated that they assist C1 going to the bathroom at least 5-6x during morning and afternoon shift and night shift staff assist client (C1) to use the bathroom at least 4x-5x during their shift.

Allegation: Staff are rough with the resident.

Based on staff and client interview, staff are not aware of any staff handling clients in roughly manner. Staff stated that they have not witnessed or heard any staff acting inappropriate behavior towards clients in care. Clients denied witnessing or hearing any staff handling clients in rough manner. Clients stated that the feel safe living at the facility.

During the visit LPA observed that clients are comfortable, well dressed and staff are attending to each client in care.

Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conduct and a copy of this report provided to staff (S4).

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC9099 (FAS) - (06/04)

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