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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200788
Report Date: 07/12/2022
Date Signed: 07/12/2022 03:43:38 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
01/21/2021 and conducted by Evaluator Leslie Ibo
COMPLAINT CONTROL NUMBER: 15-AS-20210121145214
FACILITY NAME:DEE & DJ'S ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
019200788
ADMINISTRATOR:DEON GOOLSBYFACILITY TYPE:
735
ADDRESS:10801 & 10803 JULIUS STREETTELEPHONE:
(510) 633-2020
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:6CENSUS: 6DATE:
07/12/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Deon Goolsby, Administrator TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff handled resident in a rough manner
Staff makes inappropriate comments towards resident
Resident not awarded privacy
INVESTIGATION FINDINGS:
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On 7/12/2022 at 10:25AM, Licensing Program Analyst (LPA) L.Ibo arrived unannounced to deliver complaint findings for the allegations above. LPA met with Administrator, Deon Goolsby.

During the investigation, LPA interviewed staff and clients.

Allegation: Staff handled resident in a rough manner

Based on interview, clients denied witnessing or experienced any staff handling resident in rough manner. Clients stated that they feel safe and comfortable living at the facility. Based on records review there is no known injury pertaining to staff handling clients in rough manner.


…Continued to LIC9099C…
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022
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-20210121145214
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: DEE & DJ'S ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 019200788
VISIT DATE: 07/12/2022
NARRATIVE
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Allegation: Staff makes inappropriate comments towards resident

During the course of interview, clients denied hearing or witnessed any staff making inappropriate comments towards clients. Clients stated that staff are nice and good to all clients in care. LPA interviewed staff on duty, staff denied witnessed any incident regarding the allegation above.

Allegation: Resident not awarded privacy

During the course of interview, clients stated that if they need to call someone using the house phone or their own cellphone they can stay in their own room or living room whichever the client’s preference. Clients stated that they can use the house phone in their room but there is a house rule to bring back the house phone to the living room every after use. Staff stated that all clients are free to use the facility phone to make phone calls.

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: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3