<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200090
Report Date: 11/06/2025
Date Signed: 11/06/2025 12:43:10 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
03/04/2024 and conducted by Evaluator Carol Fowler
COMPLAINT CONTROL NUMBER: 15-AS-20240304112655
FACILITY NAME:JOHNSON'S FAMILY HOME, INC.FACILITY NUMBER:
019200090
ADMINISTRATOR:NATALIE JAYNE JOHNSONFACILITY TYPE:
735
ADDRESS:670 55TH STREETTELEPHONE:
(510) 594-2274
CITY:OAKLANDSTATE: CAZIP CODE:
94609
CAPACITY:6CENSUS: 5DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:NATALIE JOHNSON, ADMINISTRATORTIME COMPLETED:
12:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not follow up with client's nurse as required
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 02/25/2025 at 10:40AM, Licensing Program Analysts (LPAs) Carol Fowler and David Doidge arrived unannounced to deliver complaint findings for the allegation above. Upon arrival, LPA met with , Natlie Johnson Administrator and explained the reason for the visit.

During the course of the investigation, the Department conducted interviews with Staff 1 (S1) Witness 1 (W1), LPA reviewed and obtained client 1 (C1). current IPP, face sheet and February behavior tracking sheet, appraisal needs and service plan, medication management, behavior conditions, police report, and doctor’s statement.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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-20240304112655
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: JOHNSON'S FAMILY HOME, INC.
FACILITY NUMBER: 019200090
VISIT DATE: 11/06/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
CONTINUE FROM LIC9099

Allegation: Staff did not follow up with client's nurse as required
Investigation Finding: unsubstantiated.

W1 stated that the Administrator left C1 in the Emergency Department and C1 had been sitting in restraints. W1 stated that W1 was trying to have a care meeting with the Administrator. W1 stated that C1 had a medication change and should be in the home setting. W1 stated that C1 had discharge orders for March 1, 2024. W1 stated W1 spoke with the Regional Center is giving W1 the run around. W1 stated that the Administrator is not accepting the client back to the facility, and the hospital dose not take care of clients with Autism and the doctor agrees. W1 stated Administrator is aware the hospital can set up transportation, but the Administrator never called back, W1 stated W1 left a voice message for the Administrator to return the call.

Interview with the Administrator revealed that the Administrator called W1 back and there was no answer, Administrator left a voice mail message. Administrator stated that Administrator is at the hospital daily with C1 and C1’s mother and the doctor and nurses are there when Administrator is visiting C1. Administrator stated that Administrator is in contact with The Regional Center. Administrator stated that the facility was in the process of a 30-day notice, the hospital found placement for C1. Therefore, this allegation is UNSUBSTANTIATED.

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.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2