015601302-8-29-2023-15-AS-KHOS-CVZRFH-20230925125909

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015601302
Report Date: 08/29/2023
Date Signed: 08/29/2023 12:05:58 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
05/30/2023 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20230530093325

FACILITY NAME:	ACACIA CREEK - UNION CITY		FACILITY NUMBER:	015601302
ADMINISTRATOR:	CHUCK MAJOR		FACILITY TYPE:	741
ADDRESS:	34400 MISSION BLVD.		TELEPHONE:	(510) 441-3700
CITY:	UNION CITY	STATE: CA	ZIP CODE:	94587
CAPACITY:	376	CENSUS: 147	DATE:	08/29/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Chuck Major, Administrator		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Staff smokes marijuana at the facility

INVESTIGATION FINDINGS:

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On this day, Aug. 29, 2023 at 10:45am Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to deliver the finding on the above allegation. LPA met with Chuck Major Administrator and explained the purpose of the visit.

Allegation: Staff smokes marijuana at the facility

During the course of investigation LPA interviews 5 residents and 4 staffs. LPA obtained and reviewed the internal reports that facility had conducted regrading the allegation above. 5 out of 5 residents stated that they have not encountered any marijuana smell on any of the staffs that were serving them. 5 out of 5 stated that they haven’t seen any staffs in the facility smokes marijuana. 4 out of 4 staff indicated that they didn’t smell any marijuana in the facility. 4 out of 4 staff states that they didn’t witness anyone that smokes marijuana at the facility. S4 indicated that there was an internal investigation with the HR department because a staff member had brough a rumor that the staff member heard. LPA reviewed the internal report indicated that the allegation that were investigated by the facility HR had concluded to be unfounded.

Report continue on LIC 90999...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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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Control Number 15-AS-20230530093325

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: ACACIA CREEK - UNION CITY	FACILITY NUMBER: 015601302
	VISIT DATE: 08/29/2023

NARRATIVE

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Based on the information gathered, there was not a substantial amount of evidence to prove that the facility staff smokes marijuana at the facility. 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.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC9099 (FAS) - (06/04)

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