<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200250
Report Date: 07/21/2022
Date Signed: 07/21/2022 01:44:06 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
06/23/2021 and conducted by Evaluator Leslie Ibo
COMPLAINT CONTROL NUMBER: 15-AS-20210623113533
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: 22DATE:
07/21/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Juliana Taboraza, Administrator & Shielha Muniz, AdministratorTIME COMPLETED:
02:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not giving resident food that resident bought
Staff yelled at resident
Food served is not of the quantity to meet resident's needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/21/2022 at 10:20AM, Licensing Program Analyst (LPA) L. Ibo 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 clients and staff.

Allegation: Staff are not giving resident food that resident bought

During the course of investigation, R1 sometimes buy food most of the time he keeps it on his room or give it to the staff to keep it in the fridge, based on staff interview when R1 ask for his food the staff always give it to him. LPA tried to interview R1, but R1 refused.

...Continue on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
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-20210623113533
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: 07/21/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff yelled at resident

Interview with residents revealed that staff does not yell at residents. Interview with staff indicated that they have not witnessed any staff yelling at residents LPA tried to interview R1, but R1 refused.

Allegation: Food served is not of the quantity to meet resident's needs.

Based on interview with staff and residents, the residents are satisfied with the quantity of food that they are receiving from the facility staff, residents also stated that if they ask for extra food the staff gives it to them without hesitation. LPA tried to interview R1, but R1 refused.


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: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2