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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201074
Report Date: 08/03/2022
Date Signed: 08/03/2022 11:52:34 AM

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
06/16/2022 and conducted by Evaluator Gregory Clark
COMPLAINT CONTROL NUMBER: 15-AS-20220616143240
FACILITY NAME:HENRY & HENRY ADULT DAY PROGRAM IIFACILITY NUMBER:
019201074
ADMINISTRATOR:HENRY, ALLENFACILITY TYPE:
775
ADDRESS:2614 SEMINARY AVENUETELEPHONE:
(510) 530-3800
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:100CENSUS: 25DATE:
08/03/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Allen Henry, LicenseeTIME COMPLETED:
11:55 AM
ALLEGATION(S):
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Client inappropriately touched by another client.
INVESTIGATION FINDINGS:
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On 8/3/22 at 11:30 a.m. Licensing Program Analyst (LPA) G. Clark conducted an unannounced visit to deliver findings for the above allegation. LPA met with Allen Henry, Licensee and explained the purpose of the visit.

During the course of investigation LPA interviewed: Reporting Party, 2 staff and 2 clients. C1 and C2's records including physician's report, IPP and program participant roster were reviewed.

Based on interviews conducted and documents reviewed C1 and C2 attend program together 3 days a week. C1 is reported to have personal boundary issues with C2. C1 will often invite C2 into her personal space and then complain to staff and others that C2 is bothering her. Staff monitor C1 and C2 closely throughout the day. The program has started a Social Skills group where they discuss, among other topics, personal space and boundaries. Both C1 and C2 attend this group.

***report cont'd on 9099c***

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022
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-20220616143240
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: HENRY & HENRY ADULT DAY PROGRAM II
FACILITY NUMBER: 019201074
VISIT DATE: 08/03/2022
NARRATIVE
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***report cont'd***

This agency has investigated the complaint. We have found that the complaint was 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.

Exit interview conducted, a copy of this reported provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2