019200955-10-8-2025-15-AS-BFOG-DPHSED-20251219124834

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200955
Report Date: 10/08/2025
Date Signed: 10/08/2025 01:22:50 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
10/06/2025 and conducted by Evaluator Carol Fowler

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20251006114820

FACILITY NAME:	DURANT HOME		FACILITY NUMBER:	019200955
ADMINISTRATOR:	SIBONGA, GABRIELE		FACILITY TYPE:	735
ADDRESS:	803 DURANT AVE		TELEPHONE:	(510) 567-8775
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94577
CAPACITY:	6	CENSUS: 5	DATE:	10/08/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Care Staff Ruel Bengco		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff would yell at residents
Staff would hit residents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 10/8/2025 at 9:45 AM, Licensing Program Analysts (LPAs) Y Brown and C. Fowler conducted an unannounced complaint visit and met with staff (ADM, S1). LPAs explained the purpose of the visit with staff. LPAs conducted interviews & record reviews and delivered investigation findings to ADM.

During investigation, LPAs obtained the following documents from ADM – Residents’ roster, Personnel Record (LIC500) / Work Schedules, disciplinary action forms and conducted staff and client interviews.

Continued on next page, LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

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-20251006114820

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: DURANT HOME	FACILITY NUMBER: 019200955
	VISIT DATE: 10/08/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff would yell at residents

Investigation Finding: Unsubstantiated

During investigation, LPAs interviewed Administrator(ADM) and staff: S1, S2, S3, S4 and S5 and interviewed clients: C1 and C2. During staff interviews, S1's interview revealed that they have not witnessed any staff members physically abusing any clients. S1 stated that they have not witnessed any staff members verbal abusing or yelling at the clients. S1 stated that some clients are hard of hearing so staff will need to raise their voices. S1 stated that S5 and W1 had a verbal argument on 9/16/2025. S1 stated that staff did not involve clients and S1 and S5 had a meeting and S5 received a disciplinary action form. Interview with S2 revealed that C1 has hard of hearing so staff have to speak louder. Interview with S3 revealed that they have not witnessed or heard about any staff member verbally abusing any clients or yelling at them. Interview with S4 revealed that they have not witnessed or heard any staff members hitting or yelling at the clients. Interview with S5 revealed that sometimes they have to raise their voices for C1 and C2 to hear them. S5 stated that they have not witnessed any staff yelling at the clients.

Allegation: Staff would hit residents

Investigation Finding: Unsubstantiated

During staff interviews, interview with S1 revealed that they have not witnessed any staff members physically abusing any clients. Interview with S2 revealed that they have not witnessed any staff physically abusing clients or ever heard staff talking about if they seen or heard anyone physically abusing clients. S3 stated that they have not witnessed or heard about any staff member physically or verbally abusing any clients.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20251006114820

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: DURANT HOME	FACILITY NUMBER: 019200955
	VISIT DATE: 10/08/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

S4 stated that they have not witnessed or heard any staff members hitting any of the clients. Interview with S5 revealed that they stated that they have not witnessed any staff hitting or yelling at clients.

Based on interviews conducted, the above allegation is 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.

There is no deficiency noted.

Exit interview conducted and a copy of this report provided

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3