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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200982
Report Date: 05/26/2022
Date Signed: 05/26/2022 07:49:18 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
09/21/2021 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20210921131741
FACILITY NAME:HEIWA GROWTH HOUSE 1FACILITY NUMBER:
019200982
ADMINISTRATOR:ONO, YUKAFACILITY TYPE:
735
ADDRESS:22857 ALICE STREETTELEPHONE:
(510) 677-6889
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:6CENSUS: 6DATE:
05/26/2022
UNANNOUNCEDTIME BEGAN:
05:30 PM
MET WITH:Lilibeth 'Beth' Toco/House ManagerTIME COMPLETED:
07:50 PM
ALLEGATION(S):
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Staff (S1) physically abused client (C1).
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation and close the complaint. LPA met with Lilibeth 'Beth' Toco, house manager. LPA called and spoke with Yuka Ono, administrator. LPA informed both of them the purpose of visit.

It was alleged that client (C1) sustained marks on the neck that resulted from S1 restraining C1.

LPA reviewed clients' files, conducted interviews, and obtained copy of police report.


.....continued next page

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
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 2
Control Number 15-AS-20210921131741
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: HEIWA GROWTH HOUSE 1
FACILITY NUMBER: 019200982
VISIT DATE: 05/26/2022
NARRATIVE
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C1 stated an incident happened when he tried to hide something in his shoes to bring to program. When S1 was to remove the sole of C1's shoes when doing body check, C1 indicated he grabbed S1 on the leg so S1 will fall on the ground and get hurt but it was him who got injured because S1 pinned him on the ground.
Three individuals (W1, W2 and W3) were interviewed. W1 indicated she observed the mark and that C1 may at times not honest but may be truthful when in danger. W2 indicated that she also observed the mark and C1 said that a staff in the facility did it; however, when C1 talked to W3, W3 said C1 told her that he lied about the incident.

Staff (S2 and S3) stated they never observed S1 hurt C1 or other clients. S2 indicated that S1 conducts body check before C1 leaves for program. On the day of the incident C1 became aggressive and kicked S1 on leg. S1 grabbed C1 on the collar to prevent C1 from falling. LPA was unable to obtain information from S1.

LPA interviewed clients (C2, C3, C4, C5 and C6). C2, C5 and C6 stated they were never hurt by any staff and never observed S1 hurt C1. LPA was unable to obtain information from C3 and C4.

Based on the information obtained during the course of investigation, and LPA unable to obtain information from S1, C3 and C4, the allegation is closed as 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.

No citation issued.

Exit interview conducted and copy of this report provided to Lilibeth Toco.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2