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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200250
Report Date: 03/17/2022
Date Signed: 03/17/2022 04:06:31 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
10/21/2021 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20211021133248
FACILITY NAME:MCCLURE CARE HOMEFACILITY NUMBER:
019200250
ADMINISTRATOR:FEDERICO ROMERO/J. TABURFACILITY TYPE:
735
ADDRESS:2903 MCCLURE STREETTELEPHONE:
(510) 272-0104
CITY:OAKLANDSTATE: CAZIP CODE:
94609
CAPACITY:25CENSUS: 21DATE:
03/17/2022
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Juliana Taburaza, Administrator
Shielha Muniz, Administrator		TIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Some of the residents clothing is missing.
Staff cuts resident clothing.
Staff hits the resident.
Staff threatens the resident.
Staff yells at the resident.
INVESTIGATION FINDINGS:
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On 3/17/2022 at 12:50PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegations above. LPA met with Administrator(s), Juliana Taburaza and Shielha Muniz.

During the course of investigation, LPA interviewed 4 clients and 3 staff. LPA also obtained and reviewed 3 client files including: physician’s report, care plan, and emergency information.

Some of the residents clothing is missing.
Interviewed with clients revealed that client were not missing their clothes. Staff stated that each client's clothes are washed and dried individually and does not commingle the client's clothes together with other clients.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
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-20211021133248
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: MCCLURE CARE HOME
FACILITY NUMBER: 019200250
VISIT DATE: 03/17/2022
NARRATIVE
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Staff cuts resident clothing.
Interviews with clients indicated that clients' clothes were not damaged or cut after clothes were cleaned by staff.

Staff hits the resident.
Interviews with clients revealed that clients did not observed any incidents were staff hit a client. Interview with staff indicated that they have not witnessed any staff hitting a client.

Staff threatens the resident.
Interview with clients indicated they have not witnessed any staff threaten clients. Staff stated that they have not witness any other staff threaten clients.

Staff yells at the resident.
Interview with clients revealed that staff does not yell at clients. Interview with staff indicated that they have not witnessed any staff yelling at clients.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegations are UNSUBSTANTIATED.

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

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2