019201322-8-28-2025-15-AS-YFLS-DL6QBQ-20250903120156

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201322
Report Date: 08/28/2025
Date Signed: 08/28/2025 04:33:44 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
07/24/2025 and conducted by Evaluator Gregory Clark

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20250724112945

FACILITY NAME:	G & C RESIDENTIAL-74TH AVENUE		FACILITY NUMBER:	019201322
ADMINISTRATOR:	JOHN F COOLEY		FACILITY TYPE:	735
ADDRESS:	1661 74TH AVENUE		TELEPHONE:	(919) 960-1906
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94621
CAPACITY:	6	CENSUS: 3	DATE:	08/28/2025
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	John Cooley, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff allowed resident to hit another resident in care
Staff spoke to resident in an inappropriate manner
Staff refused to provide food for resident

INVESTIGATION FINDINGS:

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On 8/28/25 at 4:30 PM Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver complaint findings in regard to the above allegations. LPA met with John Cooley administrator and explained the purpose of the visit.

During the course of the investigation LPA interviewed facility staff, facility residents and reviewed R1’s file. LPA was unable to interview R1 because he has moved out of the facility on 8/18/25 and left no contact information.

Facility staff (S1, S2, S3) all reported residents are not allowed to hit other residents as it is against resident rights, house rules and considered physical abuse.

***report continues on LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20250724112945

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: G & C RESIDENTIAL-74TH AVENUE	FACILITY NUMBER: 019201322
	VISIT DATE: 08/28/2025

NARRATIVE

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***report continues from LIC9099***

Facility staff (S1, S2, S3) all reported that R1 was diabetic and followed a strict diet. S3 denied ever withholding food from R1 food or calling him names. S1 and S2 reported that they never heard any staff call R1 names and that R1 never reported any complaints about any staff calling him names or denying him food during his time at the facility.

Facility residents (R2 and R3) both reported that they like living at the facility and are happy. R2 stating that he “never wants to leave.” Both R2 and R3 stated that they have never heard any of the staff call any of the residents names or seen any of the residents hitting each other or being encouraged to do so. They both feel that the residents are treated with respect. R2 and R3 also reported that they didn't have any issues with the food at the facility and never heard any of the other residents complain about the food either.

This agency has investigated the above allegations. We have found that the complaint was unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025

LIC9099 (FAS) - (06/04)

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