075600201-4-16-2025-15-AS-HHUL-DGFKP7-20250507080415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075600201
Report Date: 04/16/2025
Date Signed: 04/16/2025 10:09:48 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
10/17/2024 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20241017114113

FACILITY NAME:	REYES GUEST HOME NAVARONNE II		FACILITY NUMBER:	075600201
ADMINISTRATOR:	REYES, F		FACILITY TYPE:	740
ADDRESS:	810 NAVARONNE WAY		TELEPHONE:	(925) 691-6037
CITY:	CONCORD	STATE: CA	ZIP CODE:	94518
CAPACITY:	6	CENSUS: 5	DATE:	04/16/2025
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Rowena Lucas, Administrator		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff physically abused resident in care resulting in multiple injuries

INVESTIGATION FINDINGS:

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On 04/16/25 at 09:20 am, Licensing Program Analyst (LPA) arrived unannounced to deliver complaint investigation findings for the above allegation. LPA met with Administrator, Rowena Lucas and explained the purpose of the visit.

During the course of the investigation, the Department obtained information, conducted interviews with residents and staff, and reviewed records. On 7/1/2024, at approximately 2pm, resident (R1) was admitted to John Muir Walnut Creek Health with a chief complaint of a fall and fatigue. R1 had a CT scan of his cervical spine that showed no finding of traumatic injury or significant degenerative change. On 07/14/2024, R1 was transported to John Muir Health with a chief complaint of fatigue. R1 had been showing increased generalized weakness over the week prior and had been complaining of right rib pain. R1 was diagnosed with acute fractures, as well as multiple acute and subacute displaced right fourth through 11th rib fractures, with associated extrapleural hematoma.
Continued on 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025

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-20241017114113

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: REYES GUEST HOME NAVARONNE II	FACILITY NUMBER: 075600201
	VISIT DATE: 04/16/2025

NARRATIVE

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...Continued from 9099
Concord Police Department Officer interviewed John Muir facility staff who stated that R1’s fractured ribs would not have contributed to R1’s death. John Muir facility staff denied ever insinuating to R1’s Power of Attorney (POA) W1 that R1 was being abused and stated that if they did have reason to believe that they would have contacted law enforcement. The Concord Police Department took the report for documentation purposes only.

All facility staff interviewed denied any physically abusing ever happening to R1 while in care. The facility staff did not witness other facility staff physically abusing R1 and were unaware that R1 sustained seven fractured ribs. The facility staff were unsure how R1 sustained the injuries.

Based upon the interviews conducted and information obtained during investigation the above allegations are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means that although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur.

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025

LIC9099 (FAS) - (06/04)

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