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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600545
Report Date: 01/11/2024
Date Signed: 01/11/2024 03:59:00 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
01/02/2024 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240102142901
FACILITY NAME:ITHACA HOMEFACILITY NUMBER:
015600545
ADMINISTRATOR:DE LEON, VICTORFACILITY TYPE:
735
ADDRESS:32295 ITHACA STREETTELEPHONE:
(510) 400-3168
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:6CENSUS: 4DATE:
01/11/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Victor De Leon, Licensee/AdministratorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Facility is experiencing financial difficulties
INVESTIGATION FINDINGS:
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On 01/11/2024 starting at 10:30 AM, Licensing Program Analysts (LPAs) L. Alexander and L. Fontanilla arrived unannounced to conduct complaint investigation for the above allegation. LPAs met with Direct Support Staff, Florante "Dan" Landingin and explained the purpose of the visit. Dan phoned Licensee/Administrator, Victor De Leon, to inform LPAs arrival. Victor arrived approximately at 11:15AM.

During the course of the investigation, LPAs checked with Secretary of State website and discovered that the business license, De Leon Enterprise, LLC has been suspended since 2017. In addition, Licensee states the company has not filed the taxes for the years 2020, 2021 and 2022.

Based on record reviews and interview conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

The following deficiency is observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiency by POC date may result in additional Civil Penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
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 3
Control Number 15-AS-20240102142901
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: ITHACA HOME
FACILITY NUMBER: 015600545
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/12/2024
Section Cited
CCR
80062(a)(1)
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80062 Finances

(a) The licensee shall meet the following financial requirements: (1) Development and maintenance of a financial plan which ensures resources necessary meet operating costs for care and supervision of clients.

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Licensee/Administrator agreed to personally go to FTB to settle the tax bills. Licensee/Administrator will give proof of settled tax bill to LPAs by 3pm for POC due date.
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Based on LPAs record review and interview licensee did not comply by not filing state taxes for years 2020, 2021 and 2022.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
01/02/2024 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240102142901

FACILITY NAME:ITHACA HOMEFACILITY NUMBER:
015600545
ADMINISTRATOR:DE LEON, VICTORFACILITY TYPE:
735
ADDRESS:32295 ITHACA STREETTELEPHONE:
(510) 400-3168
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:6CENSUS: 4DATE:
01/11/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Florante Landingin, Direct Support StaffTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Staff is mishandling the clients personal funds while in care
INVESTIGATION FINDINGS:
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5
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7
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11
12
13
On 01/11/2024 starting at 10:30 AM, Licensing Program Analysts (LPAs) L. Alexander and L. Fontanilla arrived unannounced to conduct complaint investigation for the above allegation. LPAs met with Direct Support Staff, Florante "Dan" Landingin and explained the purpose of the visit. Dan phoned Licensee/Administrator, Victor De Leon, to inform LPAs arrival. Victor arrived approximately at 11:15AM.

During the course of the investigation, LPAs reviewed clients' P&I records. It was alleged staff is mishandling the clients personal funds while in care. LPAs counted the monies for two (2) clients and the P&I monies was balanced.

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.

Exit interview conducted and a copy of this report provided.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3