015600538-3-16-2022-15-AS-KHOS-CCRVNE-20220322163501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015600538
Report Date: 03/16/2022
Date Signed: 03/16/2022 03:31:57 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
01/08/2021 and conducted by Evaluator James Sampair

COMPLAINT CONTROL NUMBER: 15-AS-20210108124558

FACILITY NAME:	GOD'S GRACE II		FACILITY NUMBER:	015600538
ADMINISTRATOR:	ISABELO C REMIGIO		FACILITY TYPE:	735
ADDRESS:	8497 GALINDO DRIVE		TELEPHONE:	(925) 828-0452
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	6	CENSUS: 4	DATE:	03/16/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Isabelo Remigio		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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1. Client was not provided assistance while in care
2. Client was not properly fed while in care
3. Client does not receive medication while in care:

INVESTIGATION FINDINGS:

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On 03/16/2022 at 1:00 PM, Licensing Program Analyst (LPA) James Sampair conducted a complaint visit. Upon entering the facility, LPA explained that the purpose of the visit was to investigate this complaint. During the visit, LPA checked records, conducted interviews, and delivered the findings.

Based on the review of the records and interviews of staff and residents, the Department found that the allegations were UNSUBSTANTIATED, meaning that the allegations may have happened or are valid, but there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted. A copy of this report and a copy of the Appeal Rights were provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

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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