079200242-4-16-2026-15-AS-BFOG-DTKQ2U-20260428114741

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200242
Report Date: 04/16/2026
Date Signed: 04/16/2026 01:56:06 PM

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
11/25/2025 and conducted by Evaluator Tonica Syess-Gibson

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20251125153734

FACILITY NAME:	CICADA-LAUREL		FACILITY NUMBER:	079200242
ADMINISTRATOR:	DEBORAH COX,MARISA MCBRIDE		FACILITY TYPE:	735
ADDRESS:	2145 CONNIE LANE		TELEPHONE:	(415) 412-5851
CITY:	OAKLEY	STATE: CA	ZIP CODE:	94561
CAPACITY:	6	CENSUS: 6	DATE:	04/16/2026
		UNANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Elvira Laurente, Direct Support Staff		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff confined resident in their room.
Staff did not provide adequate supervision to manage resident's behaviors.
Staff did not assist resident with toileting.
Staff did not provide planned community activities for resident.
Licensee did not communicate with resident's responsible party regarding relocation.

INVESTIGATION FINDINGS:

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On 04/16/2026 at 9:43AM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to conduct continuance of interviews and deliver findings for the allegations above. LPA met with Elvira Laurente, Direct Support Staff and explained the reason for the visit.

During the investigation, LPA toured facility, interviewed witness (W1), staff S1, S2 and S3. LPA reviewed and obtained staff schedule, staff contact information, client’s roster, C1’s admission agreement, emergency contact information, physician’s report, individual program plan (IPP), dangerous propensity, incident reports from January thru November 2025, appraisal needs and service plan, and the facility’s activity calendar.

Continue on LIC9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026

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 3

Control Number 15-AS-20251125153734

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: CICADA-LAUREL	FACILITY NUMBER: 079200242
	VISIT DATE: 04/16/2026

NARRATIVE

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Continued from LIC9099

Staff confined resident in their room.

Interviews with staff S1, S2 and S3 revealed client (C1) sometimes want to be in his room. C1 comes downstairs and sits on couch, watching television with the other clients. Staff encourages the clients to hang out with each other after attending the day program. C1 sometimes hangs out with others and sometimes he does not. C1 would go in his room when the other clients would get noisy.

Staff did not provide adequate supervision to manage resident's behaviors.

Interview with W1 revealed W1 working with Regional Center of East Bay (RCEB) to get C1 a one-to-one staff 1:1 ratio. Record review revealed C1 does not have a 1:1, record review also revealed facility staff is sufficient in numbers to support the care needs of the clients in care.

Staff did not assist resident with toileting.

Interviews with S1, S2, and S3 revealed, C1 goes to the restroom by himself without assistance. C1 will urinate on carpet next to bed in the middle of nights and early mornings. S1 and C1’s mother agreed to place a rubber mat next to bed to prevent carpet from being destroyed.

Continued on LIC9099C.....

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20251125153734

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: CICADA-LAUREL	FACILITY NUMBER: 079200242
	VISIT DATE: 04/16/2026

NARRATIVE

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Continued from LIC9099C......

Staff did not provide planned community activities for resident.

Interviews with S1 and S2 revealed has a C1 does not like to participate in all of the activities the facility has in place for the clients. C1 likes swimming, listening to the music, singing(karaoke) and walking to the park down the street from the facility to swing, C1 loved doing simple puzzles, like shapes and fruits. C1 does enjoy jumping on the trampoline in the backyard with the other clients.

Licensee did not communicate with resident's responsible party regarding relocation.

Interviews with W1 revealed there has been communication with S1 regarding possibly moving C1’s to another home that would be best for C1 due to the level of care C1 needs. Interview with S1 revealed C1 was never moved out of home and to the other home because mom was in the process of trying to move C1 closer to her home in another city.

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

Exit interview conducted and a copy of report was given.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026

LIC9099 (FAS) - (06/04)

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