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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200148
Report Date: 07/20/2022
Date Signed: 07/20/2022 05:23:37 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
04/21/2020 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20200421134126
FACILITY NAME:REMINGTON CARE HOME #2FACILITY NUMBER:
019200148
ADMINISTRATOR:BETH NUNEZFACILITY TYPE:
735
ADDRESS:27481 ORLANDO AVETELEPHONE:
(510) 453-7043
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY:6CENSUS: 5DATE:
07/20/2022
UNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Cecilia Laurente/Staff TIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff member (S1) hit client (C1).
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Delmundo arrived unannounced to deliver the findings for the above allegation and met with staff, Cecilia Laurente. LPA spoke with Beth Nunez, licensee-administrator, over the phone, and informed the purpose of visit. Beth Nunez stated she can not come to the facility, and authorized Cecilia Laurente to sign and receive this report.

It was alleged that staff (S1) slapped/hit client (C1) during dinner time, because C1 was eating too slow.

During the course of investigation, LPA reviewed clients records. Obtained copies of documents including but not limited to LIC602 Physician’s Report, Individual Program Plan, Incident Report and C1’s Swallowing Evaluation.

....continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
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-20200421134126
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: REMINGTON CARE HOME #2
FACILITY NUMBER: 019200148
VISIT DATE: 07/20/2022
NARRATIVE
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LPA interviewed clients, C1, C2 , C3, C4, C6. C5 refused to be interviewed. C2 stated S1 hit C1. LPA was unable to obtain information from C1, C3, and C6. C4 stated S1 hit C1 but not him or other clients. When asked for additional information regarding the alleged hitting incident. C4 was not able to provide.

LPA also interviewed staff, S1, S2, S3, S4, S5, S6, S7, and administrator. S1 denied hitting or slapping C1 and/or other clients. S2, S3 and S6 stated they never observed S1 hitting C1. S4, S5 and S7 indicated S1 no longer works at the facility when they started. Administrator stated that C1 has swallowing problem and has history of choking. Administrator also stated that there were times when staff did Heimlich maneuver on C1 and the other client may not know what’s going on, and have thought that the staff is hitting C1. Interview of staff confirmed C1 has history of choking and has swallowing problem. S5 stated C1 is on supervision when eating as C1 may choke due to behavior of eating fast. Review of C1’s records and incident report corroborated with administrator and staff statements. LPA personally observed C1 eating fast and was on 1:1 supervision when eating.

Based on all information gathered, the allegation is 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 report provided to Cecilia Laurente.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2