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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200020
Report Date: 11/12/2024
Date Signed: 11/12/2024 12:53:44 PM

Unsubstantiated


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
01/30/2024 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240130160754
FACILITY NAME:GOOD SAMARITAN RESIDENTIAL CARE FACILITYFACILITY NUMBER:
019200020
ADMINISTRATOR:FRANKLIN E. BAUTISTAFACILITY TYPE:
735
ADDRESS:275 JACKSON STREETTELEPHONE:
(510) 886-1821
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:6CENSUS: 6DATE:
11/12/2024
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Elenita Miranda, CaregiverTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Sexual Abuse
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/12/2024 at 12:15 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Caregiver, Elenita Miranda, to deliver findings of above allegation. LPA explained the purpose of the visit with Caregiver and they phoned Administrator, Frank Bautista to inform. LPA went over the complaint findings with Administrator and they gave authorization for Caregiver, Elenita Miranda, to sign the report.

Allegation: Sexual Abuse
Finding: Unsubstantiated

During the course of the investigation, the Department conducted interviews with staff, clients, witnesses and reviewed records. On, or about, 1/29/2024, C1 was transferred to hospital for Suicidal Ideation and then expressed to hospital staff that C1 had been raped by another client. On 2/5/2024, the Department Interviewed C1, who provided conflicting information. C1 did not provide detail to the alleged incident and stated that while she was “in pain” in the private area due having been raped, the event took place in 2012. On 2/5/2024, the Department interviewed P1 and P2 (responding police officers) who stated that they arrived at the facility due to a behavioral disturbance by C1, whereby C1 was transferred to hospital for evaluation. P1 and P2 had no additional information. On 2/5/2024, the Department interviewed S1; and on 4/19/2024 interviewed S1, S2, S3, and C2 & C3. All stated having no knowledge of any sexual abuse having taken place. C1 could not be interviewed a second time on 4/19/2024 due to behavioral disturbance. C4 and C5 could not be interviewed. No other corroborating information emerged.

Based on records review, interviews conducted, and observations made, the Department has investigated the above allegation that client sustained sexual abuse while in care and found it to be unsubstantiated. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

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: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
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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