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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200186
Report Date: 05/17/2024
Date Signed: 05/17/2024 02:56:35 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
06/30/2023 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230630145424
FACILITY NAME:MCHAROLD HOMEFACILITY NUMBER:
019200186
ADMINISTRATOR:LORNA A.HAYAGFACILITY TYPE:
735
ADDRESS:1076 EL DORADO DRIVETELEPHONE:
(925) 245-0779
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:6CENSUS: 6DATE:
05/17/2024
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Lorna Hayag, AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Client was physically abused while in care.
INVESTIGATION FINDINGS:
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On 5/17/2024 at 1:20PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct complaint investigation and deliver findings in regards to the allegation above. LPA met with Administrator, Lorna Hayag and informed her the reason for visit.

During the course of investigation, LPA interviewed 5 clients, 5 staff, 2 witnesses, and complainant. LPA obtained and reviewed documents including physician's report, IPP, ISP, behavioral support plan, dangerous propensity, emergency information, client notes, and police report.

Interview with staff indicated no staff hit client (C1). Interview with clients revealed that majority of the clients stated that staff treats C1 good. C1's behavioral support plan revealed that C1 has a history of making false statements. In the police report, W3 informed police officer that C1 has a history of lying and telling stories of people hurting C1 to get what C1 wants. Police report indicated no injuries were observed on C1.
(Continue on LIC9099C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
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-20230630145424
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: MCHAROLD HOME
FACILITY NUMBER: 019200186
VISIT DATE: 05/17/2024
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Lorna Hayag. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2