019200678-4-12-2022-15-AS-HHUL-CDVP45-20220427105832

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200678
Report Date: 04/12/2022
Date Signed: 04/12/2022 09:54:35 AM

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
03/02/2021 and conducted by Evaluator Grace Luk

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20210302101620

FACILITY NAME:	G.L.O.M. ARF		FACILITY NUMBER:	019200678
ADMINISTRATOR:	TURNER, ALLEN DR		FACILITY TYPE:	735
ADDRESS:	2066 WALNUT STREET		TELEPHONE:	(925) 583-5775
CITY:	LIVERMORE	STATE: CA	ZIP CODE:	94551
CAPACITY:	6	CENSUS: 6	DATE:	04/12/2022
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Jessica Turner, Program Director		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Lack of Supervision – Client was inappropriately touched by another client

INVESTIGATION FINDINGS:

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On 4/12/2022 at 8:50AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to deliver complaint findings for the allegation above. Upon arrival, LPA met with Program Director, Jessica Turner and explained to her the reason for the visit.

During the course of the investigation, the Department conducted interviews with staff, clients, witnesses, and complainant. Client’s physician’s report, care plan, care notes, incident reports, and police reports were obtained and reviewed.

On 2/28/2021, while on an outing, C2 reported to staff that C1 grabbed C2’s bottom. Interview with staff revealed that no one witnessed the incident. After the incident, staff (S2) spoke with C1 about not touching people inappropriately. Later, on the same day, C1 tried to hit C2 and S2 quickly stood in between the two clients. Staff separated the two clients for the reminder of the day. (Continue on LIC9099C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

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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Control Number 15-AS-20210302101620

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: G.L.O.M. ARF	FACILITY NUMBER: 019200678
	VISIT DATE: 04/12/2022

NARRATIVE

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Interview with clients indicated staff provided adequate supervision at the facility and client felt safe. Interview with staff indicated that there are 3-4 staff working on AM and PM shift, and 1 staff working on NOC shift. Staff stated that C1’s medications were reduced about a month prior to the incident. After the incident, C1 was sent to the hospital for evaluation and C1’s medications were adjusted. Since the medication change, C1 did not have another incident of inappropriate touching of others.

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.

Exit interview conducted. A copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

LIC9099 (FAS) - (06/04)

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