019200250-5-23-2023-15-AS-KHOS-CYFKSA-20231212070914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200250
Report Date: 05/23/2023
Date Signed: 05/23/2023 07:14:10 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
05/15/2023 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20230515145650

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:	05/23/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Juliana Taburaza/Licensee and Sheilha Muniz/Administrator		TIME COMPLETED:	07:10 PM

ALLEGATION(S):

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-Staff did not safeguard resident's personal belongings.

-Staff are not providing resident with a comfortable environment.

-Staff are not providing adequate food service to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegations. LPA met with staff, Norman Nelson Luat and Maria Luisa Talavera, and informed the reason for visit Juliana Taburaza, licensee, and Sheilha Muniz, administrator, arrived after about 30 minutes.

LPA obtained copies of resident roster, sample menu and resident's folllowing documents: LIC601 Identification and Emergency Information; LIC602 Physician's Report; LIC621 Client/Resident Personal Property And Valuables; Unusual Incident Reports. LPA conducted inspection and interviewed staff (4 staff and licensee). 7 residents and facility liason (W1).

Allegation: Staff did not safeguard resident's personal belongings
It was alleged that R1's hat was gone missing. It was also alleged on 5/15/23 that staff stole R1's pen, notebook and computer.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20230515145650

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: 05/23/2023

NARRATIVE

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Four of the staff interviewed denied taking any of R1's belongings. All 4 stated they have seen R1 using his computer which R1 keeps in his backpack with lock and takes with him when he leaves the facility. Three of the staff stated that one of the resident's TV and DVD were reported missing by the resident, and were found in R1's room. Three (3) out of 7 residents interviewed stated they lost money but do not know who took it while the other 4 indicated they never lost any of their belongings. One of the 7 residents stated seeing R1 using his computer over the weekend, days after the computer was reported missing on 5/15/23.

Allegation: Staff are not providing resident with a comfortable environment.
It was alleged that staff (S1) is always bothering and following R1, and staff is always screaming. All 4 staff interviewed denied the allegation. One (1) out of 7 residents interviewed stated that staff (S3) yelled at R2 but it happened about a year ago, and has not happen lately. The other 6 residents indicated staff never yell at them. W1 stated that the issue is about R1's personality and behavior.

Allegation: Staff are not providing adequate food service to residents.
LPA inspected the perishable and non-perishable food supplies which were observed adequate and of different varieties consistent with dish listed on the sample menu. All four staff interviewed provided information of food/meal serve of different varieties. Although 2 of the 7 residents stated they want to see more of vegetables on the meals served, all 7 residents interviewed stated food is good and they get filled.

Based on all information gathered during the course of investigation, the allegations are closed as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiency cited. The licensee and administrator have to leave before LPA completed this report. The licensee authorized Maria Luisa Talavera to sign and receive this report.

Exit interview conducted, and copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

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