019200250-4-15-2026-15-AS-BFOG-DTD2YY-20260421174931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200250
Report Date: 04/15/2026
Date Signed: 04/15/2026 01:45:51 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
02/11/2026 and conducted by Evaluator David Doidge

COMPLAINT CONTROL NUMBER: 15-AS-20260211151152

FACILITY NAME:	MCCLURE CARE HOME		FACILITY NUMBER:	019200250
ADMINISTRATOR:	MUNIZ, SHIELHA C		FACILITY TYPE:	735
ADDRESS:	2903 MCCLURE STREET		TELEPHONE:	(510) 272-0104
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94609
CAPACITY:	25	CENSUS: 23	DATE:	04/15/2026
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Administrator Shielha Muniz		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility did not ensure adequate supervision resulting in a resident altercation

INVESTIGATION FINDINGS:

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*THIS IS AN AMENDMENT OF REPORT DATED 02/17/2026*
On 02/17/2026 at 11:20 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct an initial 10-day complaint investigation and to deliver findings in regards to the allegation above. LPA met with House Manager Norman Nelson Luat and explained the purpose of the visit. Administrator Shielha Muniz arrived at 12:20 PM.

During the course of the investigation, LPA obtained copies of R1 and R2’s Physician’s Report, Appraisal Needs and Services Plan, Admission Agreement, and the Identification and Emergency sheet. LPA also obtained the facility’s staff timesheets. LPA interviewed R2, R3, S1,and S3 in the facility. S2 and LPA spoke on the phone.

Allegations: Facility did not ensure adequate supervision resulting in a resident altercation

Continued on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026

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 3

Control Number 15-AS-20260211151152

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: MCCLURE CARE HOME	FACILITY NUMBER: 019200250
	VISIT DATE: 04/15/2026

NARRATIVE

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Continued from LIC9099

Investigation Findings: It was reported to the department that a resident, R1 hit another resident, R2, in the nose multiple times and there were no staff present at the time. LPA observed three staff present when LPA arrived. Staff reported that on the day of the incident, R1 was in the facility and planning on joining the other residents for dinner. LPA interviewed R2 who said staff were preparing dinner and setting the dining room when R1 walked over to R2, and out of nowhere, R1 grabbed R2’s face and slapped at R2 hitting R2’s nose. R2 backed away and left the dining room. Staff reported that R1 went to R1’s room. R1 was not available to interview. Staff did not observe the altercation as it happened too quickly. R2 reported it to staff before breakfast the next day. S1, S2 and S3 said R1 is rarely in the facility and leaves very early in the morning so R1 was not around when S1 called the police. R2 and R3 said R1 puts other residents on edge when R1 is in the facility. S1, S2, R1 and R3 say most staff and residents give R1 a lot of space and try to not interact with R1. File review shows R1 has a diagnosis of Schizoaffective and Schizophrenia. R1 has a history of not taking medications and being confrontational. S2 and S3 confirmed there have been four incidents involving R1 since January, in which police have had to come out. S1, S2 and S3 all feel R1’s behavior is getting to a point that R1 may not be able to stay in the facility much longer. Although the facility appears to have enough staff, staff do not have a behavior plan in place for R1 to ensure the other residents are safe from R1’s behavior. The incident occurred due to behavior issues with one resident that is not taking medication and who’s behavior is too erratic and not being mitigated by the facility. Based on interviews and record reviews conducted, the above allegation is substantiated.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED.

Deficiency is cited from Title 22 California Code of Regulations (see LIC9099D). Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in an additional civil penalty.

Deficiency and plan and proof of correction were discussed with Administrator Shielha Muniz.

Exit interview conducted, Appeal Rights, and a copy this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20260211151152

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: MCCLURE CARE HOME	FACILITY NUMBER: 019200250
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/15/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/29/2026 Section Cited CCR 85065(b)	1 2 3 4 5 6 7	85065 Personnel Requirements (b) The licensee shall employ staff as necessary to ensure provision of care and supervision to meet client needs.	1 2 3 4 5 6 7	By POC date, Administrator agrees to hold resident meeting to anseer questions and put residents at ease. Administrator will issue an inservice training with staff to remind staff of R1’s behaviors and to monitor R1 move closely when R1 is in the facility. Administrator will document meeting and provide proof to LPA by POC date.
	8 9 10 11 12 13 14	Based on record review and interview the Licensee did not comply with the section cited above in not having adequate staff to resident altercation for clients in care which posed a health and safety risk to person in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026

LIC9099 (FAS) - (06/04)

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