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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200654
Report Date: 02/23/2022
Date Signed: 02/23/2022 07:00:50 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
06/04/2021 and conducted by Evaluator Leslie Ibo
COMPLAINT CONTROL NUMBER: 15-AS-20210604131506
FACILITY NAME:CENTRAL HOMEFACILITY NUMBER:
019200654
ADMINISTRATOR:RUDY GILILAO, JRFACILITY TYPE:
735
ADDRESS:862 CENTRAL BLVD.TELEPHONE:
(925) 683-1818
CITY:HAYWARDSTATE: CAZIP CODE:
94542
CAPACITY:4CENSUS: 2DATE:
02/23/2022
UNANNOUNCEDTIME BEGAN:
07:00 PM
MET WITH:Christine Joy Pagdatu, StaffTIME COMPLETED:
07:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff slapped a resident in care.
Staff threatened resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day 2/23/2022, Licensing Program Analyst (LPA) Leslie Ibo arrived unannounced to deliver findings on the above allegations. LPA met with Christine Pagdatu, staff, Administrator is not available during the visit.

On 6/7/2021, LPA Luisa Fontanilla initiated 10-day investigation, interviewed Administrator, Client 1 (C1) and Staff 1 (S1), obtained and reviewed C1’s Individual Program Plan (IPP).
Based on interviews conducted, S1 who is the primary caregiver for C1 denied hurting C1. S1 states C1 is like a sibling and would never hurt C1 or any other client. When interviewed by LPA, C1 states C1 likes the staff at the home because they are fair. C1 denied getting hurt or threatened by any staff or witnessing any staff hurt a client.
Based on interviews conducted and records review, the above allegations are unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.
There is no deficiency noted.
Exit interview was conducted with Administrator and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
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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