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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600144
Report Date: 09/19/2024
Date Signed: 09/19/2024 09:50:46 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
09/10/2024 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20240910110714
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: 3DATE:
09/19/2024
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Demauriee Inghram, Staff TIME COMPLETED:
10:05 AM
ALLEGATION(S):
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Staff spoke inappropriately to resident in care
INVESTIGATION FINDINGS:
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On 9/19/2024 at 8:55 AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger and Ardalan Gharachorloo arrived unannounced to conduct a complaint visit. LPA explained the purpose of the visit with Staff, Demauriee Inghram. Adminstrator Anthony Hodges was called and designated his staff to sign off on the report

During the initial 10-day complaint visit. LPA interviewed staff, collected the following documents: R's ISP and IEP.

During the investigation, LPAs spoke with administrator,Anthony Hodges over the phone. Administrator mentioned that the client wanted to transition to independent living, but based on the review of the documents including but not limited to IEP, there are life skill goals that are still not met and are require the client to get help with life skills.

Report continue on LIC 9099 C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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-20240910110714
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: 09/19/2024
NARRATIVE
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...Continued from LIC 9099

Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2