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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200083
Report Date: 11/16/2022
Date Signed: 11/16/2022 05:43:33 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
08/20/2020 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20200820111319
FACILITY NAME:FRANKLIN HOME CARE IIFACILITY NUMBER:
079200083
ADMINISTRATOR:JOSEFINA B. NAGTALONFACILITY TYPE:
735
ADDRESS:5208 MESA RIDGE DRIVETELEPHONE:
(925) 777-3392
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 4DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Kevon Moreau, AdministratorTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Facility staff deny resident water
Facility staff do not provide snacks for residents
Facility staff did not seek medical attention for resident
INVESTIGATION FINDINGS:
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On 11/16/2022 at 03:15 PM, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced visit to deliver the findings for the above allegations. LPA was greeted by Care Staff who contacted Kevon Moreau, Administrator (ADM) and explained the purpose for the visit. ADM arrived about 10 minutes later.

Licensing Program Analyst D. Panlilio conducted a Facetime tele-visit with ADM on 08/21/20 in order to meet the initial 10-day complaint notification for the above allegations. During the course of the investigation, interviews and record reviews, LPA L. Holmes interviewed three (3) Staff and attempted to interview four (4) Clients. For the above allegations, interviews with Staff #1 (S1) and Staff #2 (S2) revealed that breakfast, lunch and dinner are served between the hours of 07:30 AM to 5:30 PM, and snacks throughout the day with water, tea, juice, and soda are available. S2 and S3 assist with scheduling medical and dental appointments and if immediate emergency attentionon is needed all staff are to use their best judgement when calling 911.

...continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
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-20200820111319
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: FRANKLIN HOME CARE II
FACILITY NUMBER: 079200083
VISIT DATE: 11/16/2022
NARRATIVE
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...continued from 9099

Client #1 (C1) has no complaints with the facility and receives everything needed, Client #2 (C2) agreed to being treated well, Client #3 (C3) is non-verbal and Client #4 (C4) agreed that she drinks water, tea and coffee. C1 stated that C4 took everything from everyone and was messing with everyones head. S2 and S4 stated that C4 had aggressive behaviors, would leave the facility through the day and force staff to have to follow him/her throughout the neighborhood. S1 and S2 stated that C4 would attempt to take items like jewelry, food, gifts, and clothing from any and everyone at the facility. C4 take others foods, would overeat to the extend of being hospitalized. S1 and S2 would utilize CRP and Portia Bell Hume Behavioral Heath and Training Center as crisis intervention for C4's behavior 2-3 times a week. Around 08/2020 to 09/2020 RCEB's Case Manager, Gaby Solis relocated C4 to a more appropriate facility in Antioch, CA.

Allegation Findings: UNSUBSTANTIATED
Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are unsubstantiated. Exit Interview conducted and a copy of this report provided to Kevon Moreau, Administrator.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2