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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011441025
Report Date: 06/06/2023
Date Signed: 06/06/2023 03:54:18 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
02/07/2022 and conducted by Evaluator Luisa Fontanilla
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20220207094906
FACILITY NAME:ARLEEN'S RESIDENTIAL CARE #3FACILITY NUMBER:
011441025
ADMINISTRATOR:NICHOLAS MARCELOFACILITY TYPE:
735
ADDRESS:32302 CREST LANETELEPHONE:
(510) 477-6700
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:6CENSUS: 6DATE:
06/06/2023
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Marino VillarealTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Personal Rights
INVESTIGATION FINDINGS:
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On this day at around 3:10 pm, Licensing Program Analyst (LPA) Luisa Fontanilla arrived at the facility to deliver finding for the above allegation. LPA met with Marino Villareal and explained the purpose of visit.

During the course of investigation, then LPA Lizette Francisco initiated 10-day investigation and obtained records on 2/14/2022. On 4/8/2022, LPA Francisco interviewed 2 staff, 1 client and attempted to interview another client. LPA Francisco was not able to interview other clients as they are nonverbal/unable to communicate. Client interviewed state staff treat clients well. Staff intervewed state clients are treated well at the facility.

On 3/17/2022, this complaint was reassigned to LPA Luisa Fontanilla. On 5/31/2023, LPA Fontanilla interviewed Client 1 (C1) with assistance from day program on tactile communication. C1 confirmed with LPA that Staff 1 (S1) pushed C1 and that C1 got hurt from the incident.

***continuation on Lic 9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
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-20220207094906
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: 06/06/2023
NARRATIVE
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LPA Fontanilla was unable to interview staff involved as the staff does not work at the facility anymore.

A review of C1's High Risk and Dangerous Propensities Record indicates that C1 exhibits False allegation of abuse where C1 will accuse staff, peers and/or community members....

Based on interviews conducted and records review, staff and client interviewed all denied any knowledge or witnessing staff mistreating a client therefore the above 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.

There is no deficiency noted for this visit.

A copy of this report was provided to Villareal.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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