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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200202
Report Date: 12/28/2023
Date Signed: 01/11/2024 10:15:48 AM

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
10/18/2023 and conducted by Evaluator Luisa Fontanilla
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20231018140936
FACILITY NAME:MALAMA HOMEFACILITY NUMBER:
019200202
ADMINISTRATOR:THELMA B. RUIZFACILITY TYPE:
735
ADDRESS:4467 LISA DRIVETELEPHONE:
(510) 475-8052
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:4CENSUS: 4DATE:
12/28/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Monica TamayoTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Facility staff yell and hit resident.
INVESTIGATION FINDINGS:
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On this day at around 10:30am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to deliver finding on the above allegation and met with Monica Tamayo. LPA explained to Tamayo the purpose of the visit. Administrator was informed over the phone and authorized Tamayo to sign the report.

During the course of investigation, LPA conducted interviews and record reviews. On 10/18/2023, LPA initiated 10-day investigation and conducted interviews and obtained records. On 11/7/2023, LPA interviewed Witness 1 (W1). On 12/7/2023, LPA conducted a collateral visit. On 12/28/23, LPA interviewed S3.
Based on interviews conducted with witnesses, S2 was observed yelling and slapping Client 1 (C1) while in the car. S2 denied the allegation stating that S2 has been taking care of C1 for approximately seven years and has never yelled or hurt C1 or any client at the facility. Other staff interviewed denied any staff yell or hit any client.

continuation on Lic 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
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-20231018140936
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: MALAMA HOME
FACILITY NUMBER: 019200202
VISIT DATE: 12/28/2023
NARRATIVE
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On 10/18/2023, S1 states the police came to the facility and conducted welfare check on C1. S1 states the police left. While at the facility, LPA tried to interview C1 and asked if C1 is okay. C1 is nonverbal but was able to give a hand sign to LPA. S1 states that it is C1’s “Okay” hand signal.

On 12/7/2023, LPA conducted a collateral visit to the RP’s location where the alleged yelling/hitting occurred. During the visit, LPA observed the place was busy with people going in and out. The location where the witnesses were from C1 and S2 was approximately 15-20 feet away and was enclosed with glass. Both doors going in and out of the office are made of glass. The parking lot where S2 and C1 car was parked is in an angled location that LPA did not have a clear view because it was partly covered. On 12/28/23, LPA interviewed S3 who states that the police came on 11/16/23 to check on C1. S3 states C1 gave the officer the "Okay" hand sign. S3 states the officer did not say anything to staff then left the facility.

Based on observation, interviews and record reviews conducted, the 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.



There is no deficiency noted.

Note: This is an amended copy from the report issued on 12/28/23.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2