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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200982
Report Date: 10/20/2022
Date Signed: 10/20/2022 05:49:02 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
04/27/2022 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20220427141253
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:
10/20/2022
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Lilibeth 'Beth' Toco/House ManagerTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff failed to safeguard resident's (R1) personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Alicia Delmundo and Lori Alexander arrived unannounced to continue the investigation and close the complaint. LPAs met with Lilibeth 'Beth' Toco, house manager. LPA Delmundo spoke with Yuka Ono, administrator, who stated she can come to the facility. and authorized Lilibeth Toco to sign and receive this report.

During the course of investigation, LPA Delmundo conducted interviews and obtained copies of R1’s documents including but not limited to LIC601 Identification and Emergency Information, LIC602 Physician’s Report, incident reports, Individual Program Plan (IPP); Addendum to IPP; Health Care Contact Record


....continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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 4
Control Number 15-AS-20220427141253
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: 10/20/2022
NARRATIVE
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It was alleged that staff failed to safeguard resident's (R1) personal belongings. It was reported that staff stole R1’s belongings.

During interview, R1 indicated that staff (S1) took and swapped S1’s airPod with his. R1 stated that he wants his airPod back; however, when further interviewed, R1 stated he put S1’s airPod back to S1’s backpack.

Staff (S1 and S2) were interviewed. S1 denied taking R1’s airPod and stated that his airPod is Apple brand while R1’s is a cheaper version and R1 wanted his. S1 stated R1 took S1’s airPod. S2 indicated R1 does not have airPod but has the cheaper brand.

R1’s family member (FM) was also interviewed and indicated R1 has airPod that R1 may have misplaced and that staff will never steal it. Two individuals (W1 and W2) who has known and come in direct contact with R1 indicated they have not seen R1 with airPod.

Residents (R2, R3 and R4) stated they never lost any of their personal belongings.

Based on the information gathered, 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: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC9099 (FAS) - (06/04)
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