019201322-6-1-2026-15-AS-LFRO-DVVJZW-20260711073013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201322
Report Date: 06/01/2026
Date Signed: 06/01/2026 11:46:13 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
01/15/2026 and conducted by Evaluator Ardalan Gharachorloo

COMPLAINT CONTROL NUMBER: 15-AS-20260115082658

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:	06/01/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Joh Cooley, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff do not ensure the facility is kept in clean sanitary conditions at all times
Staff did not prevent residents from engaging in a physical altercation with another adult
Staff do not prevent residents from using illegal drugs in the facility
Staff do not prevent residents from consuming alcohol in the facility
Staff leave residents unsupervised
Licensee does not ensure administrator on the premises the number of hours necessary to manage the facility

INVESTIGATION FINDINGS:

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On 06/01/2026 at 9:30 AM Licensing Program Analyst (LPA) Ardalan Gharachorloo 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.

Allegation: Facility is not maintained in clean and sanitary condition at all times - Unsubstantiated

The LPA conducted an unannounced complaint investigation visit and toured the facility, including but not limited to resident bedrooms, bathrooms, kitchen, dining areas, common,areas, and exterior grounds. During the tour, the LPA observed the facility to be maintained in a generally clean and sanitary condition.
Resident rooms appeared orderly and free from odors, bathrooms were observed to be clean and operable, and common areas were maintained in a sanitary condition.

***CONTINUE ON 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

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-20260115082658

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: G & C RESIDENTIAL-74TH AVENUE	FACILITY NUMBER: 019201322
	VISIT DATE: 06/01/2026

NARRATIVE

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***CONTINUE FROM 9099***

The LPA interviewed Staff 1 (S1), Staff 2 (S2), Staff 3 (S3), and Clients 1 through 3 (C1-C3). Staff
interviewed reported routine cleaning and housekeeping practices were conducted throughout the
facility. Clients interviewed did not report concerns regarding the overall cleanliness of the facility.

Allegation: Staff did not prevent residents from engaging in a physical altercation with
another adult - Unsubstantiated

LPA interviewed S1-S3 and C1-C3 regarding allegation above. Staff interviewed denied witnessing
residents engage in a physical altercation with another adult and reported no knowledge of an
incident matching the allegation. Clients interviewed similarly denied witnessing or having
knowledge of residents physically assaulting another individual.The LPA reviewed resident records, staff records, recent incident report, the LIC 500 Personnel Report, and staff schedules.

Allegation :Staff did not prevent residents from using illegal drugs in the facility - Unsubstantiated

As part of the investigation, the LPA reviewed information obtained from interviews conducted by the Department with C1. During the interview, C1 denied ever observing residents use fentanyl, heroin, or other illegal narcotics within the facility. C1 reported believing another resident may have injected an unknown substance but acknowledged not knowing what substance, if any, was involved. C1 further reported the resident had medical conditions requiring injectable medications and stated staff had not located prohibited substances during room searches. Additional interviews conducted by the LPA with C2 and C3 did not produce information corroborating the allegation. The LPA also reviewed resident records.

***CONTINUE ON 9099C***

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 15-AS-20260115082658

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: G & C RESIDENTIAL-74TH AVENUE	FACILITY NUMBER: 019201322
	VISIT DATE: 06/01/2026

NARRATIVE

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***CONTINUE FROM 9099C***

Allegation: Staff did not prevent residents from consuming alcohol in the facility - Unsubstantiated

The LPA interviewed S1-S3 and C1-C3 regarding allegations that residents consumed alcohol
within the facility and that staff failed to prevent such conduct. Staff interviewed denied observing
residents improperly consuming alcohol within the facility and reported residents are routinely
supervised and monitored throughout the day. Staff further reported they would address behaviors
that present a health or safety concern. Clients interviewed did not provide information corroborating the allegation.

Allegation: Staff leave residents unsupervised - Unsubstantiated

On 01/16/2026 and 06/01/2026, the LPA conducted a tour of the facility and observed staff present during the visit. LPA also reviewed staff schedule for the month. The LPA interviewed S1-S3 and C1-C3 regarding allegations that residents were left unsupervised. C1 stated that C1 is observing staff throughout the day and is "not recognizing any staffing issues" in the facility. In addition C2 did not express concerns regarding staff not being present in the facility. Both C1 and C2 attend day program throughout the day. Staff interviewed reported staff coverage is maintained throughout scheduled shifts and residents are provided supervision consistent with their needs. LPA also reviewed the current LIC500.

***CONTINUE ON 9099C***

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 15-AS-20260115082658

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: G & C RESIDENTIAL-74TH AVENUE	FACILITY NUMBER: 019201322
	VISIT DATE: 06/01/2026

NARRATIVE

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***CONTINUE FROM 9099C***

The LPA reviewed the LIC 500 Personnel Report, and staff schedules.Records reviewed reflected staff coverage during the periods reviewed.

Allegation : Licensee failed to ensure the administrator is present the number of hours
necessary to manage the facility - Unsubstantiated

The LPA interviewed S1-S3 and C1-C3 regarding allegations that the administrator was not present
at the facility the number of hours necessary to manage facility operations. LPA interviewed C1 and C2 who both stated " they see the administrator and other staff on a routine basis" Staff interviewed
reported the administrator remained involved in facility operations and was available to staff when
needed. LPA interviewed S1 and S2 who both stated that Administrator is in the facility 4-5 days per week. LPA reviewed the most recent staff schedule.

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: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

LIC9099 (FAS) - (06/04)

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