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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200202
Report Date: 09/18/2024
Date Signed: 09/18/2024 04:26:57 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
09/12/2024 and conducted by Evaluator Luisa Fontanilla
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240912090238
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:
09/18/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Charisma AguilarTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff yelled at a client
Staff threatened a client with eviction
Staff prevented a client from making telephone calls
INVESTIGATION FINDINGS:
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On this day at around 1 pm, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct investigation on the above allegations and met with Charisma Aguilar. LPA explained to
Aguilar the purpose of the purpose. The Administrator Thelma Ruiz was also present during the visit.

During the course of investigation, LPA interviewed Client 1 (C1), Administrator, House Manager and co Licensee. LPA obtained the following records for C1: Emergency Identification and Information, IPP, Physician's Report

Based on interviews conducted, C1 states that C1 likes living in the facility because the staff cares about C1.
And that C1 can talk to the staff. C1 states that C1 was able to contact the Crisis team previously. C1 states that the Crisis team program is on hold for now per advise from C1's mother.

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

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
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-20240912090238
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: 09/18/2024
NARRATIVE
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In regards to the eviction allegation, C1 states that C1 had a conversation with Staff 3 (S3) regarding C1's failure to attend the day program regularly. However, C1 states eviction was not part of the conversation. S3 states that C1 was advised to make sure to go to the day program regularly as it will help C1 grow more. Both S1 and S3 denied yelling or threatening C1 with eviction.

In regards to the allegation that staff prevented C1 from making phone calls, Staff 1 (S1) states that C1 used to call the Crisis team a lot at different times. This information was confirmed by C1 with LPA. However, C1 and staff informed LPA that C1's mom advised the facility and C1 that the program is currently on hold.

During the visit, LPA observed C1 communicating with all staff including S3. C1 appeared happy and comfortable.

Based on interviews conducted and LPA observations, the above allegations are unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2