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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200347
Report Date: 10/15/2021
Date Signed: 10/15/2021 01:24:55 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
11/08/2019 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20191108164510
FACILITY NAME:MISSION HOPE DAY PROGRAM, FREMONTFACILITY NUMBER:
019200347
ADMINISTRATOR:NISSIE ESCOLANOFACILITY TYPE:
775
ADDRESS:43154 OSGOOD ROADTELEPHONE:
(510) 226-1600
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY:45CENSUS: 15DATE:
10/15/2021
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Danny Rey Mazon, Case ManagerTIME COMPLETED:
01:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff had sex with client
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/15/21 at 12:45PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct a subsequent complaint visit and deliver the investigation finding. LPA explained the purpose of the visit with the case manager (CM). LPA spoke with Program Director on the phone who authorized CM to act on her behalf and sign the report.

Based on interviews and record reviews, client (C1) made inconsistent statements about being sexually assaulted. C1 was unable to provide accurate details regarding location and witnesses to the alleged assault. C1 told LPA she does not remember any details of the incident she reported in October 2019. LPA interviewed staff who denied that the incident occurred. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated.

No deficiencies cited. Exit Interview conducted and a copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
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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