015600144-1-25-2023-15-AS-KHOS-CP3PPY-20230215103018

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015600144
Report Date: 01/25/2023
Date Signed: 01/25/2023 11:46:36 AM

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
01/19/2023 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20230119125558

FACILITY NAME:	HODGES RESIDENTIAL FACILITY		FACILITY NUMBER:	015600144
ADMINISTRATOR:	HODGES, A., C., & T.		FACILITY TYPE:	735
ADDRESS:	3320 LOMA VISTA WAY		TELEPHONE:	(510) 536-0998
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94619
CAPACITY:	6	CENSUS: 6	DATE:	01/25/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Demauriee Ingraham, Direct Support Professional		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are not administering residents medication
Staff are not providing adequate food service for resident
Staff are not providing a safe environment for residents
Staff are not treating resident with respect

INVESTIGATION FINDINGS:

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On 1/25/23 at 9:00AM, Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced complaint visit, met with direct support professional (DSP) Demauriee Ingraham. Administrator (ADM) Anthony Hodges was not available at the time. Demauriee gave Anthony a call for LPA to explained the purposed of the visit. Administrator was not available to come and gives verbal mission for Demauriee to sign the report.

It was alleged that Staff are not administering resident’s medication, however base on recorded reviewed of medication administration record (MAR) showed that staff are administering Clients medications.

It was alleged that Staff are not providing adequate food service for resident. However, LPA interviewed C1, S1 and S2 and observed that facility have significant of food choices for Clients. C1 states that the facility staff always gives us three meals a day, with food option.

Report continue on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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-20230119125558

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: HODGES RESIDENTIAL FACILITY	FACILITY NUMBER: 015600144
	VISIT DATE: 01/25/2023

NARRATIVE

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It was alleged that Staff are not providing a safe environment for residents, however LPA interviewed C1 states that C1 feel safe at the facility/ environment, and everyone here gets along with the staff. C1 states that Staff here help us and provide us with assistance.

It was alleged that Staff are not treating resident with respect, however LPA interviewed C1, S1, and S2 states that everyone here have to follow the house rule is to respect one another, and C1, S1, and S2 have not witness, nor heard of any staff disrespect any Clients.

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.

A copy of this report is provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC9099 (FAS) - (06/04)

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