019200661-8-13-2024-15-AS-HHUL-D8SRWH-20240904132309

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200661
Report Date: 08/13/2024
Date Signed: 08/13/2024 02:03:33 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
04/19/2024 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20240419170428

FACILITY NAME:	ROSE GARDEN VISTA		FACILITY NUMBER:	019200661
ADMINISTRATOR:	HASMIN B KOO		FACILITY TYPE:	735
ADDRESS:	1615 HIGH STREET		TELEPHONE:	(510) 533-4929
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY:	15	CENSUS: 12	DATE:	08/13/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Haidie Bautista, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Sexual Abuse

INVESTIGATION FINDINGS:

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On 8/13/24 at 11:00 a.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings in regard to the allegation above. LPA met with Haidie Bautista, Administrator and explained the purpose of the visit.

During the course of the investigation the department interviewed the reporting party (RP), the alleged victim (R1), four facility staff (S1, S2, S3, S4) and three facility residents (R2, R3 and R4). The department also reviewed R1’s file.

R1’s file documented that R1 has a diagnosis of schizophrenia and a long history of making sexual assault allegations. R1’s needs and service plan dated 2/12/23 states “R1 has a history of making sexual accusations towards staff in previous placement. R1 is also noted to be sexually preoccupied and makes various statements of a sexual nature. Facility male staff is to continue not to approach her due to this history.” ****report continues on LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

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 3

Control Number 15-AS-20240419170428

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: ROSE GARDEN VISTA	FACILITY NUMBER: 019200661
	VISIT DATE: 08/13/2024

NARRATIVE

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****report continues from LIC9099***

R1’s admission summary from Villa Fairmont dated 4/01/24 states: “R1 is noted as sexually preoccupied, making several statements of a sexual nature.”

The RP stated that she has known R1 for about a year. RP is aware of R1’s long history of making sexual assault allegations. However, the RP thought that this allegation needed to be investigated because “of the consistent nature in which R1 told the story.”

Interview with S1 revealed no information pertinent to this investigation as S1 only saw R1 for a few months before S1 went on an extended vacation. S1 did say that she never observed any inappropriate interactions between S3 and R1.

Interview with S2 revealed that S2 never heard R1 complain about S3 or act afraid or uncomfortable around him. S2 also stated that R1 is completely independent in her activity of daily living and that R1 showered independently without staff assistance.

Interview with S3 revealed that has he been working at the facility for over 20 years. S3 stated that he has never touched R1 in an inappropriate manner, hugged, held hands, or kissed her. S3 denied ever sounding like he was flirting or making obscene or rude gestures towards R1. S3 also denied ever going into R1's room when she was inside.

Interview with S4 revealed that S4 was well aware of R1’s history of making sexual assault allegations, having hallucinations and paranoia. S4 stated that R1 lived at the facility for about a year but was discharged to a Crisis Treatment Center on 4/19/24 due to increased paranoia and hallucination symptoms. R1 did not return to the facility. S4 further stated that she did not believe that any inappropriate behavior happened between R1 and S3. S4 has never received a complaint about S3 in the 10 years that she has been working at the facility.

***report continues on LIC9099C***

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20240419170428

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: ROSE GARDEN VISTA	FACILITY NUMBER: 019200661
	VISIT DATE: 08/13/2024

NARRATIVE

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***report continues from LIC9099C***

Interviews with all three residents (R2, R3 and R4) revealed that all three were very happy with their treatment at the facility. They all reported that they liked living there and that the staff were kind and supportive. None of the residents had any issues with any of the staff.

The department has investigated the complaint alleging sexual abuse. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC9099 (FAS) - (06/04)

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