015600144-5-3-2023-15-AS-KHOS-CURRNV-20230816131057

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015600144
Report Date: 05/03/2023
Date Signed: 05/03/2023 12:36:19 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
04/28/2023 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20230428150817

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:	05/03/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Anthony Hodges, Adminstrator		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Staff did not safeguard client's personal belongings
Staff did not ensure client uses designated smoking area to smoke
Staff did not prevent the presence of rodents in the facility
Facility has mold in client bedroom

INVESTIGATION FINDINGS:

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On 5/3/23 at 10:30AM, 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. Anthony Hodges later arrived at 12:00pm.

It was alleged that Staff did not safeguard client's personal belongings, however LPA interviewed S2 states “No body have…told me that their properties got damage. If they come to me and said that their belonging got damage in my facility then I am gladly replacing it, because it not their fault. I haven’t heard anything. I don’t have a safeguard documentation for clients if they tell me they have no belonging”.

Report continue on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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-20230428150817

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: 05/03/2023

NARRATIVE

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It was alleged Staff did not ensure client uses designated smoking area to smoke, however LPA interviewed C1, C1 stated “. I haven’t seen or smell any cigarette while I am inside the room. Everyone knows that if they want to smoke it have to be in the back yard”. LPA interviewed S1, and S2 stated that they haven’t heard anyone complaint about clients smoking inside the facility nor the bedroom. S2 strictly stated “If the client tells me that if they see any one smoke in the room or facility, I would personally talk to them, and reiterate the house rules. If they continue to not follow the rules, then I make a call RCEB and discuss further action. Verbal, written, and termination”.

Staff did not prevent the presence of rodents in the facility, however LPA interviewed C1 stated “I haven’t seen any rodents anywhere. I heard that there was a mouse back then inside C2 room. But S2 took care of that right away. Their room is messy and dirty”. LPA interviewed S2 stated “There was a small mouse inside C2 room. His roommate told me about mouse. I took action and put the sticky trap inside the room, and within two days we caught the mouse. I continue to leave mouse trap inside the room because the way that they live. I just want to make sure that there’s no mouse coming back”.

It was alleged that Facility has mold in client bedroom, however at 11:30am LPA toured the facility including client’s room, kitchen, family room, and bathroom. LPA observed that there was no mold inside the facility or client’s bedroom.

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 via email.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC9099 (FAS) - (06/04)

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