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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201125
Report Date: 09/30/2024
Date Signed: 09/30/2024 02:55:40 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
09/27/2024 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20240927102705
FACILITY NAME:GLEN EDENFACILITY NUMBER:
019201125
ADMINISTRATOR:RAMAS, ELINOREFACILITY TYPE:
735
ADDRESS:238 ESTHER COURTTELEPHONE:
(510) 940-8382
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:4CENSUS: 4DATE:
09/30/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Fatima Lacsamana, AdministratorTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff member hit Client at facility.
INVESTIGATION FINDINGS:
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On 09/30/24 at 1:45 PM, Licensing Program Analyst (LPA) Kelly Nguyen arrived unannounced to delivered finding for the above allegations. LPA explained the purpose of the visit with administrator, Fatima Lacsamana.

Allegation: Staff member hit Client at facility- Unsubstantiated
During investigation, LPA interviewed staff (S1 S2, S3, S4, and Rising Star Program Director) along with clients (C1, C2 and attempted to interview C3, and C4). 4 out of 4 staff including program stated that C2 tends to make up false allegations. C2 IPP Addendum date on 3/12/24 stated C2 behaviors that re-occurring on a regular basis are…habitual lying…C2 stated that C2 do no recalled any staff hit C2, and the incident that happened was a very long time ago that C2 do not want to talk about it only remembered C2 was having an aggression that leads to C2 breaking thing and staff tried to help calm C2 down, and got sent to John George. C2 deny that staff hit C2.

Report Continued on LIC 9099C...

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
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-20240927102705
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: GLEN EDEN
FACILITY NUMBER: 019201125
VISIT DATE: 09/30/2024
NARRATIVE
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Based on interviews conducted, and records reviewed, LPA found the above allegations to be unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

Exit interview conducted with Administrator and copy of this report provided via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2