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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600144
Report Date: 01/25/2023
Date Signed: 01/25/2023 11:48:08 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-20230119092215
FACILITY NAME:HODGES RESIDENTIAL FACILITYFACILITY NUMBER:
015600144
ADMINISTRATOR:HODGES, A., C., & T.FACILITY TYPE:
735
ADDRESS:3320 LOMA VISTA WAYTELEPHONE:
(510) 536-0998
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:6CENSUS: 6DATE:
01/25/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Demauriee Ingraham, Direct Support ProfessionalTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility staff does not transport residents to scheduled doctors appointments.
ty staff withholds residents SSI money.
Facility staff takes residents SSI money.
Facility bathroom is in disrepair.
INVESTIGATION FINDINGS:
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On 1/25/23 at 11:30AM, 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 explain the purpose of the visit. Administrator was not available to come and gives verbal mission for Demauriee to sign the report.

It was alleged that Facility staff does not transport residents to scheduled doctors’ appointments. However, LPA interviewed C1, S1, and S2 states that the facility staff takes Clients to doctor appointments, and made appointment for Clients.

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)
Page: 1 of 2
Control Number 15-AS-20230119092215
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 ty staff withholds residents SSI money, and Facility staff takes residents SSI money. However, LPA interviewed S1 and S2 and reviewed residents safeguarded cash resource logs shown records of Clients beginning balance and amount that are giving clients weekly with the client signature that they received the money. S1 states that clients SSI money goes towards rent.

It was alleged that Facility bathroom is in disrepair. LPA observed that the downstair bathroom is in working condition, but the flow of the water is slow. S1 states that S1 will contact the plumper and figure out the slow flow of the water.

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)
Page: 2 of 2