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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200842
Report Date: 06/20/2025
Date Signed: 06/20/2025 10:42:02 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
01/27/2025 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250127121722
FACILITY NAME:G.L.O.M. ARF 2FACILITY NUMBER:
019200842
ADMINISTRATOR:TURNER, ALLENFACILITY TYPE:
735
ADDRESS:1885 WALNUT STREETTELEPHONE:
(925) 583-5555
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY:6CENSUS: 6DATE:
06/20/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Ken Manu, Program DirectorTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Staff yells at residents
INVESTIGATION FINDINGS:
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13
On 6/20/2025 at 9:15AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with staff, Angela Anderson and explained the purpose of the visit. Program Director, Ken Manu arrived 15 minutes later.

During the course of investigation, LPA interviewed 4 clients, 3 staff, witnesses, and complainant. LPA reviewed and obtained documents including staff roster with contact information, emergency information, and facility notes. Interview with complainant indicated that S4 would yell at clients while at the facility and in public. Interview with clients and witnesses revealed that they have witnessed staff yelling at clients.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted with Ken Manu. A copy of this report and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
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-20250127121722
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 2
FACILITY NUMBER: 019200842
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2025
Section Cited
CCR
80072(a)(1)
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Personal Rights. To be accorded dignity in his/her personal relationships with staff and other persons. This requirement is not met as evidence by:
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Program Director (PD) has agreed to conduct training for staff regarding personal rights, conduct internal investigation, and corrective action as needed.
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Based on interviews, licensee did not comply with the section cited above by staff yelling at clients which poses a potential personal rights violation to the persons in care.
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PD will submit training documents and staff sign-in sheet to CCLD by POC date.
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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: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
01/27/2025 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250127121722

FACILITY NAME:G.L.O.M. ARF 2FACILITY NUMBER:
019200842
ADMINISTRATOR:TURNER, ALLENFACILITY TYPE:
735
ADDRESS:1885 WALNUT STREETTELEPHONE:
(925) 583-5555
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY:6CENSUS: 6DATE:
06/20/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Ken Manu, Program DirectorTIME COMPLETED:
10:55 AM
ALLEGATION(S):
1
2
3
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9
Staff do not maintain a comfortable environment for residents in the facility
INVESTIGATION FINDINGS:
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13
On 6/20/2025 at 9:15AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with staff, Angela Anderson and explained the purpose of the visit. Program Director, Ken Manu arrived 15 minutes later.

During the course of investigation, LPA interviewed 4 clients, 3 staff, witnesses, and complainant. LPA reviewed and obtained documents including staff roster with contact information, emergency information, and facility notes. Interview with clients revealed that majority of the clients feels safe living at the facility. Interview with staff indicated that the clients and staff all get along like family.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Ken Manu. A copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3