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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600562
Report Date: 12/23/2022
Date Signed: 12/23/2022 05:36:28 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
12/19/2022 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20221219084318
FACILITY NAME:MORNING SUN CARE HOMEFACILITY NUMBER:
015600562
ADMINISTRATOR:GALANG, ROSARIOFACILITY TYPE:
735
ADDRESS:1502 171ST STREETTELEPHONE:
(510) 481-9708
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:6CENSUS: 5DATE:
12/23/2022
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Maria Theresa "Tek" Ordiniza/Assistant AdministratorTIME COMPLETED:
05:35 PM
ALLEGATION(S):
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Staff speaks to resident (R1) in an inappropriate manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegation. LPA met with Assistant Administrator Maria Theresa "Tek" Ordiniza, and informed the purpose of visit.

LPA obtained copies of R1's Individual Service Plan and interviewed residents (R1, R2, R3, R4 and R5), staff (S1, S2 and S3) and R1's RCEB case manager (CM).

It was alleged that staff (S1) has been calling resident (R1) derogatory names. CM indicated R1 did not provide specifics about staff calling R1 derogatory names. LPA interviewed R1 who stated S1 calls him "star" and/or "dad". LPA interviewed staff (S1, S2 and S3) who all denied calling R1 such names.


.......continued on 9099C







Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2022
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-20221219084318
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: MORNING SUN CARE HOME
FACILITY NUMBER: 015600562
VISIT DATE: 12/23/2022
NARRATIVE
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Residents R2, R2 and R4 stated they never heard S1 or other staff calls R1 'star' or 'dad'. Although R5 stated he does not remember R1, no staff call him or other residents names.

Based on information obtained, the allegation is closed as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiency cited.

Exit interview conducted and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2