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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011441026
Report Date: 09/05/2024
Date Signed: 09/05/2024 04:46:27 PM

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
01/03/2024 and conducted by Evaluator Luisa Fontanilla
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240103160006
FACILITY NAME:BROADWAY HOMEFACILITY NUMBER:
011441026
ADMINISTRATOR:DELEON, IMELDA F.FACILITY TYPE:
735
ADDRESS:6185 BROADWAY AVENUETELEPHONE:
(510) 894-3311
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY:6CENSUS: 4DATE:
09/05/2024
UNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Anita TamposTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility is not ensuring that residents' P & I monies are received on a timely basis.
Facility is experiencing financial difficulties.
INVESTIGATION FINDINGS:
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On this day at around 3:50pm, Licensing Program Analysts (LPAs) Luisa Fontanilla and Patricia Manalo arrived unannounced to deliver findings on the above allegations. LPAs met with staff Anita Tampos. Licensee/Administrator Imelda De Leon is currently out on vacation. LPAs explained to Tampos the purpose of the visit.

On 1/3/2024, the department received a complaint alleging that the 1) Facility is experiencing financial difficulties and 2) Facility is not ensuring that residents' P & I monies are received on a timely basis.

On 1/5/2024, LPA conducted 10-day visit and obtained records. On 2/13/2024, a referral for financial audit was made to the Audit Section. On 3/22/2024, an engagement letter was emailed to the Licensee requesting for documents to be submitted on 4/25/2024. The Licensee did not respond to the request and did not submit any documents.
continuation on Lic 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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 3
Control Number 15-AS-20240103160006
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: BROADWAY HOME
FACILITY NUMBER: 011441026
VISIT DATE: 09/05/2024
NARRATIVE
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On 7/23/2024, the financial audit report was received at the Oakland Regional Office. Based on the report, the “Licensee did not respond to the documents request and did not provide any documents by the due date. Licensee did not provide any requested items, including LIC 401, LIC 403, utility bills, bank statements, workers' compensation policy, ...

“The licensee did not comply with all applicable laws & regulations because the licensee failed to provide required information and documentation to carry out the solvency audits ...

Based on records reviewed and interview conducted, clients’ P&I money checks from RCEB gets to the facility’s P.O. Box approximately every 11th or 12th of each month. Then, the Administrator deposits the money to the facility bank account and withdraws the cash and takes the money to the facility for the clients’ use.

Based on interview conducted with the Administrator, P&I monies are received every 11th or 12th of each month, gets deposited to the bank then withdrawn and made available to the clients usually by the 15th of each month.

A review of the P&I log indicates that P&I monies get logged on the last week of each month, which is approximately two weeks after upon receipt of the monies from RCEB.

Based on interview conducted with Witness 1 (W1), the latest that P&I monies get received by the facilities is the 15th of each month and should be made available to the clients immediately.

W1 further stated that making the P&I monies available to the clients two weeks after receipt is unacceptable unless there is valid reason. This allegation is substantiated.

Based on LPA record reviews and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22, are being cited on the attached LIC 9099D

Exit interview was conducted with the Administrator and Appeal Rights was provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20240103160006
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: BROADWAY HOME
FACILITY NUMBER: 011441026
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/19/2024
Section Cited
CCR
80062(a)(1)
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80062(a)(1) Finances
(a) The licensee shall meet the following financial requirements:
(1) Development and maintenance of a financial plan which ensures resources necessary meet operating costs for care and supervision of clients.
This requirement is not met as evidenced by: The facility did not submit financial records that were requested by the auditor which poses an immediate risk to the health and safety of the clients under care.
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A Non-Compliance Conference (NCC) is scheduled on September 19, 2024.
Type A
09/19/2024
Section Cited
CCR
80062(a)(2)
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80062(a)(2) Maintenance of financial records.(a) The licensee shall meet the following financial requirements:
(2) Maintenance of financial records.
This requirement is not met as evidenced by: The facility did not submit financial records that were requested by the auditor which poses an immediate risk to the health and safety of clients under care.

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A Non-Compliance Conference (NCC) is scheduled on September 19, 2024.
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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: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
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