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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200205
Report Date: 09/04/2025
Date Signed: 09/04/2025 09:36:29 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
07/16/2025 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20250716163242
FACILITY NAME:CROW CANYON RESIDENTIAL CARE 1FACILITY NUMBER:
079200205
ADMINISTRATOR:RUFFY B. YUFACILITY TYPE:
735
ADDRESS:47 BIGELOW PLACETELEPHONE:
(925) 361-5285
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:6CENSUS: 6DATE:
09/04/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:House Manager, Den LuzonTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff did not administer resident's medication
Staff did not prevent resident from showing another resident inappropriate videos
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) A Gomez returned to deliver complaint investigation findings and met with House Manager, Den Luzon and explained the purpose of the visit.

On both allegations, during the investigation LPA reviewed documents and conducted interviews.

Report continues on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
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-20250716163242
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: CROW CANYON RESIDENTIAL CARE 1
FACILITY NUMBER: 079200205
VISIT DATE: 09/04/2025
NARRATIVE
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 LPA found during interviews on 7/25/25 that facility is not preventing clients from watching explicit material in their rooms however regulations allow for residents to watch what they would like per their personal rights. LPA also found through interviews that C1 has headaches and sometimes needs Tylenol however it is as needed and C1 does not express a need. LPA advised staff to try to ask clients more about their pain and offer medications as needed. Therefore both allegations are UNSUBSTANTIATED.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2