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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011441172
Report Date: 05/24/2023
Date Signed: 05/24/2023 03:38:33 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
05/18/2023 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20230518102515
FACILITY NAME:ARLEEN'S RESIDENTIAL CARE #4FACILITY NUMBER:
011441172
ADMINISTRATOR:BATANGOSO, ANNIEFACILITY TYPE:
735
ADDRESS:2097 DUVAL LANETELEPHONE:
(510) 780-0940
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY:4CENSUS: 3DATE:
05/24/2023
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Annie Batangoso/Administrator and
Lilibeth Lopez/Back-up Administrator		TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff violated clients' personal rights.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegation. LPA met with Annie Batangoso, administrator, and Lilibeth Lopez, back-up administrator. LPA informed the reason for visit.

LPA obtained copies of staff schedule, reviewed clients' records, and obtained copies of the following clents' following current documents: LIC602A Physician's Report; Individual Program Plan; LIC625 Apprasal/Needs and Services Plan. LPA interviewed staff (S1, S2, S3 and S4), residents (R1, R2 and R3), and witness (W1), and inspected the garage.

It was alleged that residents were given showers in the garage with the garage door open.

.....continued next page
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
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-20230518102515
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 #4
FACILITY NUMBER: 011441172
VISIT DATE: 05/24/2023
NARRATIVE
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LPA interviewed witness (W1) who stated that on May 13, 2023, W1 saw a staff (name unknown) giving a bath to a naked client (name unknown) in facility garage that is open. W1 also indicated that the client ran away and was redirected by staff back to the facility. On May 15, 2023, W1 again witnessed two naked clients being given a bath in the garage. However, when verified. W1 stated that W1 assumed the clients were being given a bath, because the clients' hair were damped.

LPA inspected the garage which showed no bathroom nor faucet. Although the garage is attached to the main house, there's no direct access from the house to the garage. One has to exit the main house and enter through the garage door or through the back door to gain access.

All 4 staff stated no clients take a bath nor given a bath in the garage. All residents can take a bath on their own. All 4 staff also stated none of the clients go to the garage naked nor have bolting and/or AWOL behaviors, LPA reviewed all 3 clients' records which confirmed the staff statements. LIC602A Physician's Reports showed all 3 residents can take a bath on their own.

All 3 clients stated they take a bath in the bathroom inside the facility, and never go out of their rooms or to the garage naked.

Based on all information gathered during the course of investigation, the allegation is closed as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiency cited.

Exit interview conducted, and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2