015600144-5-3-2023-15-AS-KHOS-CRLPAK-20230507110851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015600144
Report Date: 02/22/2023
Date Signed: 05/03/2023 10:18:42 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
02/17/2023 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20230217142619

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: 5	DATE:	02/22/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Demauriee Ingraham, Direct Support Professional		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility staff blow marijuana smoke in residents' faces.
Facility staff are under the influence while at work.
Facility staff do not treat residents with dignity and respect.
Facility staff harass residents.
Facility staff did not ensure that resident received medications.
Facility does not provide a safe environment for residents.

INVESTIGATION FINDINGS:

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***This is an amendment to the 9099 originally issued on 2/22/23***

On 2/22/23 at 1:0PM, 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.

Allegation: Facility staff blow marijuana smoke in residents' faces.
Unsubstantiated

On 2/22/23 LPA interviewed 5 staffs, and 3 residents. 5 out of 5 states that they never blow marijuana or witness any of staffs blow marijuana smoke in residents faces. LPA interviewed 3 residents, 3 out of 3 states staffs did not blow marijuana smoke nor witness any of the staffs blow marijuana smoke in any residents faces.

Report Continue on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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-20230217142619

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: 02/22/2023

NARRATIVE

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Allegation: Facility staff are under the influence while at work.

Unsubstantiated

On 2/22/23 LPA interviewed 5 staffs, and 3 residents. 5 out of 5 states that they never come to work under the influences or witness any of staffs under the influences while at work. LPA interviewed 3 residents, 3 out of 3 have not seen any staffs nor witness any staffs under the influence while at work.

Allegation: Facility staff did not ensure that resident received medications.

Unsubstantiated

On 2/22/23 LPA interviewed 5 staffs, 3 residents, and reviewed medication log. 5 out of 5 staffs states we make sure that we gave residents medication, and we make sure to log them. 3 out of 3 residents states that we all take our medication, and staffs make sure we takes our medication and we saw them log it. LPA observed medication log if fully completed with the staff signature on the days that the medication was giving to the residents

Allegation: Facility staff do not treat residents with dignity and respect. Facility staff harass residents, and facility does not provide a safe environment for residents.

Unsubstantiated

On 2/22/23 LPA interviewed 5 staffs, and 3 residents. 5 out of 5 states that they always treat residents here with dignity and respect. LPA interviewed 3 residents, 3 out of 3 states that everyone here treats everyone with dignity and respect. 5 out of 5 staffs states that they never harassed nor witness any staffs harassed any residents here. R1 states “staff does not harass anyone here, nor harassed me”. 5 out of 5 staffs states they tried their best to create a comfortable environment, and a safe environment for all the residents. R2 states “I felt really save here, and staffs tried their best to make us feel comfortable”.

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: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

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