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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200462
Report Date: 04/04/2024
Date Signed: 04/04/2024 07:06:03 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
03/27/2024 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20240327144832
FACILITY NAME:JULIAN FAMILY CAREHOMEFACILITY NUMBER:
019200462
ADMINISTRATOR:MARCIAL D. JULIANFACILITY TYPE:
740
ADDRESS:26798 CONTESSA STREETTELEPHONE:
(510) 783-5216
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY:6CENSUS: 3DATE:
04/04/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Staff, Belinda Dela CruzTIME COMPLETED:
07:15 PM
ALLEGATION(S):
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Staff physically abused resident (R1) in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Delmundo arrived unannouced to investigate the above allegation. LPA met with staff, Belinda Dela Cruz, and informed the reason for visit. LPA called and spoke over the phone with Marcial Julian, administrator, who authorized Belinda Dela Cruz to sign and receive this report.

It was alleged that on March 15, 2024, the administrator pushed R1.

During investigation, LPA reviewed residents' files and obtained copies of documents. LPA interviewed staff (S1, S2 and administrator), residents (R1, R2 and R3) and witness (W1).


.......continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024
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-20240327144832
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: JULIAN FAMILY CAREHOME
FACILITY NUMBER: 019200462
VISIT DATE: 04/04/2024
NARRATIVE
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W1 stated resident (R1) told W1 that on March 15, 2024 the administrator pushed R1; however, on the alleged day of incident, the administrator was out on vacation and not in the facility which LPA confirmed with S1, S2, R2 and administrator.

S1, S2, R2 and R3 stated they never observed the administrator pushed R1 nor physically abusive to any of the residents. R1 stated the administrator run into R1's leg. The administrator stated that an incident happened when he first brought R1 to appointment. He was helping R1 get into the his car and R1 put his leg first in the car which caused R1 pain.

Based on information gathered. the allegation of staff physically abused resident in care is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiency cited.

Exit interview conducted, and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2