079200212-4-8-2025-15-AS-HHUL-DFXSU7-20250421141036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200212
Report Date: 04/08/2025
Date Signed: 04/08/2025 02:12:58 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
08/26/2024 and conducted by Evaluator Laura Hall

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20240826122419

FACILITY NAME:	RES SUCCESS		FACILITY NUMBER:	079200212
ADMINISTRATOR:	FABIOLA DELA TORRE		FACILITY TYPE:	775
ADDRESS:	2980 RAILROAD AVENUE		TELEPHONE:	(925) 473-9552
CITY:	PITTSBURG	STATE: CA	ZIP CODE:	94565
CAPACITY:	72	CENSUS: 42	DATE:	04/08/2025
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Fabiola De La Torre, Program Manager		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are inappropriately isolating client
Staff threatened client
Staff did not safeguard client's personal belongings
Staff inappropriately punished client
Staff made inappropriate comments towards resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 4/8/2025 at 1:45pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint findings for the allegations above. LPA met with Fabiola De La Torre, Program Manager and explained the reason for the visit.

During the course of the investigation the Department conducted interviews with witness, staff, and clients. All the allegations were reported to W1 through an anonymous email. Based on the investigation the above allegations are unsubstantiated.

Allegation: Staff are inappropriately isolating client.
The anonymous email stated that C1 would be put in the music room and was told he

Continued LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

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 3

Control Number 15-AS-20240826122419

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: RES SUCCESS	FACILITY NUMBER: 079200212
	VISIT DATE: 04/08/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued LIC9099C.

couldn’t leave. On 8/30/2024, LPA interviewed S5, S6, S7, and S8. All four (4) of the staff interviewed stated C1 was put in the music room if he would cough or not doing what S9 or S10 wanted him to do. S5 and S6 stated during interview that most of the time C1’s isolation was inappropriate. S6 stated C1 would sneeze and be isolated. LPA interviewed S2, S3, S4 the same day, and S9 and S10 on 10/1/2024. Those staff interviewed stated they have observed C1 go into the music room but didn’t feel he was being isolated inappropriately.
Allegation: Staff threatened client.

The anonymous email stated C1 was threatened by chastising him. During interview with C1 no admission of threatening was reported. S6 stated S10 would threaten C1’s that his case manager would be called. S10 would also tell C1 she will call his dad or a staff member. S7 recalled during interview an incident where the clients were going on an outing and S10 would plays mind games and erase C1's name even though C1 was going on the outing. The other stuff stated they did not hear of or observe C1 being threatened.

Allegation: Staff did not safeguard client's personal belongings

The anonymous email stated staff stole the client’s water bottle and eyeglasses. S5 stated C1 had said he lost his glass out loud and S9 replied C1 didn't lose his glasses, then S9 brought them out. S5 stated she believes S9 took them from him. S6 and S8 stated during interview S10 hides C1's water bottle by placing it on top of the glass display. Eventually the water bottle or glasses are given back. The other staff interviewed did not have any knowledge of client’s personal belongings being taken or hidden.

Continued on LIC9099C.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20240826122419

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: RES SUCCESS	FACILITY NUMBER: 079200212
	VISIT DATE: 04/08/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC9099C.

Allegation: Staff inappropriately punished client

The anonymous email stated staff would put the client in a corner facing a wall. S7 recalled a couple of weeks ago S10 played mind games and would erase C1's name off the list for a client outing, even though, C1’s was going. S7 also stated S10 doesn't allow C1 to fill his water bottle but doesn’t do it to any other client. S8 stated S9 will isolate C1 in a room because he's not doing exactly what she wants. S8 also stated when S10 wants C6 away from her he is also put in the isolation room.

Allegation: Staff made inappropriate comments towards resident

The anonymous email stated S2 teases the participants when S1 is not present. S1 stated during interview on 10/1/2024, that she had no knowledge or was it brought to her attention that inappropriate comments were being made. S5 stated C1 has been teased about his clothes and hair. S6 stated S10 tells C1 he is going to get kicked out of the program and that his dad doesn’t like him. S6 stated they are all right here in the main room when C1 tries to say something they mock him. S5 stated the way S10 talks to C1 isn't right. S5 stated she hears some comments here and there from other staff but not directly to the clients.

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

Exit interview conducted and a copy of report was given.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3