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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600538
Report Date: 09/22/2022
Date Signed: 09/22/2022 01:11:18 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
11/17/2021 and conducted by Evaluator Lizette Francisco
COMPLAINT CONTROL NUMBER: 15-AS-20211117084015
FACILITY NAME:GOD'S GRACE IIFACILITY NUMBER:
015600538
ADMINISTRATOR:ISABELO C REMIGIOFACILITY TYPE:
735
ADDRESS:8497 GALINDO DRIVETELEPHONE:
(925) 828-0452
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:6CENSUS: DATE:
09/22/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Isabelo Remigio, AdministratorTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Staff mishandles a client's diabetic need while in care
Staff used inappropriate language towards a client
Staff pinched a client while in care
Staff hit a client while in care
INVESTIGATION FINDINGS:
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On 9/22/2022 at 10:30 AM, Licensing Program Analysts (LPAs) L. Francisco and K. Nguyen arrived unannounced to conduct complaint investigation for the above allegations. LPAs met with Administrator Isabelo Remigio and explained the purpose of the visit.

During the course of the investigation, LPAs obtained information, collected documents, interviewed staff and clients. It was alleged staff mishandles a client's diabetic need while in care. Based on information obtained, C1 does not like how S1 pokes her when checking C1's glucose level. However, LPA discovered during an interview with C1 that once C1 informed staff of the incident, S1 no longer was assigned to check C1's glucose level.

REPORT CONTINUES ON 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
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-20211117084015
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: GOD'S GRACE II
FACILITY NUMBER: 015600538
VISIT DATE: 09/22/2022
NARRATIVE
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It was alleged staff used inappropriate language towards a client. Based on information obtained, staff cursed at client. However, LPAs interviewed 2 clients and 2 of 2 denied staff cursing at them. LPA interviewed 3 staff of which 3 of 3 denied the allegation.

It was alleged staff pinched a client while in care. Based on interview with C1, C1 witnessed S1 pinched C2. However, interview with S1 and S2 revealed that S1 does not provide direct care for C2.

It was alleged staff hit a client while in care. Based on information obtained, staff kicked client on the stomach. During an interview with C1, she stated that she did not report incident during the time it occurred and there were no witnesses. Interview with 3 staff revealed they were not aware of C1 being kicked by staff.
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: Lizette Francisco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2