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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200309
Report Date: 09/23/2022
Date Signed: 09/23/2022 10:17:12 AM

Substantiated


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
08/13/2020 and conducted by Evaluator Liridon Fici
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20200813135623
FACILITY NAME:GLENN VIEWFACILITY NUMBER:
019200309
ADMINISTRATOR:KRISTABELLE ALATASFACILITY TYPE:
735
ADDRESS:38524 GLENVIEW DRIVETELEPHONE:
(510) 894-1971
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:3CENSUS: 0DATE:
09/23/2022
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Josephine Abella, Administrator TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff is inappropriately locking clients in the home
INVESTIGATION FINDINGS:
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On 8/13/2020, LPA A. Delmundo initially open the 10-day complaint. On today’s date 9/23/2022, Licensing Program Analyst L. Fici (LPA) and Licensing Program Manager Y. Flores-Larios (LPM) arrived unannounced to deliver investigation findings on the above allegation. LPA and LPM met with Josephine Abella, Administrator (ADM) and explained the purpose of the visit.

During the course of the investigation, LPA A. Delmundo interviewed staff and clients regarding the above allegation. LPA Delmundo also received the following documents for C1: IPP, Quarterly ISP, Behavior Intervention Plan for 2019 and 2020, and Physician report.

Continue on Lic9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022
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 3
Control Number 15-AS-20200813135623
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: GLENN VIEW
FACILITY NUMBER: 019200309
VISIT DATE: 09/23/2022
NARRATIVE
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During interviews with staff and clients, both care staff and clients stated that doorknobs are removed and/or loosened to prevent clients from leaving the facility.
Based on LPAs interviews and record reviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted with ADM, report provided along with appeal rights.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20200813135623
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: GLENN VIEW
FACILITY NUMBER: 019200309
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited
CCR
80072(a)(7)
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Personal rights: (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(7) Not to be locked in any room, building, or facility premises by day or night.
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Administrator agrees to review personal rights and submit a self-certification to CCL by POC due date.
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This requirement is not met as evidenced by:

Based on Interview and record review, the licensee did not comply with the section cited above in not allowing clients to leave the facility, which poses a potential health and safety risk to persons in care.
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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: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3