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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200723
Report Date: 07/31/2024
Date Signed: 07/31/2024 10:22:40 AM

Substantiated


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
10/26/2023 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20231026151036
FACILITY NAME:KIMBILIOFACILITY NUMBER:
019200723
ADMINISTRATOR:ALANNA SPENCERFACILITY TYPE:
772
ADDRESS:1480 159TH STREETTELEPHONE:
(510) 200-9134
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:14CENSUS: 7DATE:
07/31/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jonathan Haskins Case manager TIME COMPLETED:
10:45 AM
ALLEGATION(S):
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A client was sexually assaulted by a staff person while in care
Staff not associated with the facility
INVESTIGATION FINDINGS:
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On 7/31/2024 at 9:15 am Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to deliver findings on the above allegation. LPA met Facility staffJonathan Haskins and explained the reason for the visit. Administrator Reine DeCiel was called and designated Jonathan Haskins to sign off on the report.

The Department’s investigation included but was not limited to interviews with current and former staff and a former client. The Department also collected records, including police reports and Alameda County Sheriff’s Department’s report. The Department obtained copies of the 2020 email communication thread between staff (S1) and staff (S2) and a record of conversation involving S1. Incident reports, resident weekly notes, and employee roster for 2020 were also reviewed and copies were obtained.

On the allegation: A client was sexually assaulted by a staff person while in care.
On 10/19/2020, C1 was interviewed by Alameda County Sheriff’s Department. During the interview process, C1 stated S1 had sexually assaulted her.
Continued on LIC 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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 4
Control Number 15-AS-20231026151036
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: KIMBILIO
FACILITY NUMBER: 019200723
VISIT DATE: 07/31/2024
NARRATIVE
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...Continued from LIC 9099

S1 asked C1 to come with him to a private room and offered C1 a massage. S1 then approached C1 and began hugging her by wrapping his arms around her body. S1 continued to lower his hands down her back, eventually placing both of his hands inside C1’s pants and grabbed her buttocks. C1 told S1 she needed to go to bed and heard S1 return to her room several more times to see if she was awake, but C1 acted like she was asleep and did not respond. C1 wished to pursue a criminal complaint against S1.

It is also indicated in the report that the officer believed S1 not to be credible as S1 clearly lied several times throughout the interview process.

Interviews with facility staff confirmed that both C2 and C1 accused S1 of inappropriate touching within five months of the other. S1 and all other staff received a warning to remain professional and be careful around the female clients. S1 was placed on administrative leave with pay before eventually being terminated from his position.

A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.


On the allegation: Staff not associated with the facility.

Based on records review, S1 was never associated with the facility. The facility did provide an employee list from 2020 showing S1 listed as a staff member. LPA searched in Guardian and found that S1 has never been associated to the facility.

A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 9099D. A $500.00 immediate civil penalty is assessed today.



Exit interview conducted. Appeal Rights, LIC421IM, and copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
10/26/2023 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20231026151036

FACILITY NAME:KIMBILIOFACILITY NUMBER:
019200723
ADMINISTRATOR:ALANNA SPENCERFACILITY TYPE:
772
ADDRESS:1480 159TH STREETTELEPHONE:
(510) 200-9134
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:14CENSUS: DATE:
07/31/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jonathan Haskins Case managerTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Facility did not report incident as required
INVESTIGATION FINDINGS:
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On July 31, 2024 at 9:15 am Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to deliver findings on the above allegation.

On the allegation: Facility did not report incident as required.
Based on records review, the facility did create an incident report to inform licensing of the situation. The incident report was dated 10/20/2020 the day after the incident occurred. The Investigator received the requested incident report on 1/22/2024 from the Human Resource Manager, S3.

Based on the investigation, above allegation will be deemed 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.
Exit interview conducted and copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20231026151036
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: KIMBILIO
FACILITY NUMBER: 019200723
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/07/2024
Section Cited
CCR
81072(a)(3)
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Each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, ..., sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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The facility agrees to conduct an inservice training for all staff with the training topic being sexual harrassment. Proof of correction will be sent to CCLD by POC date.
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Based on interviews and records review, R1 was sexually assulted by a S1 while in care.
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Type A
08/07/2024
Section Cited
CCR
81019(e)(2)
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All individuals subject to a criminal record review pursuant to Health and Safety Code section 1522 shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 81019(f).
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A $500.00 immediate civil penalty is assessed on this day. The facility also agrees to review the regulation reguarding criminal records clearence and submit a self certified statment. Proof of correction will be sent to CCLD by POC date.
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Based on interviews and records review, S1 was working at the facility without having a criminal records clearance.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4