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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200308
Report Date: 02/07/2025
Date Signed: 02/07/2025 09:11:47 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
12/04/2024 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20241204140243
FACILITY NAME:SHIRLEY'S CARE HOMEFACILITY NUMBER:
079200308
ADMINISTRATOR:JONES, SHIRLEYFACILITY TYPE:
735
ADDRESS:203 JOAQUIN DRIVETELEPHONE:
(925) 806-0515
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY:6CENSUS: 5DATE:
02/07/2025
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Administrator, Shirley Jones TIME COMPLETED:
09:25 AM
ALLEGATION(S):
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Staff neglecting Clients in Care
Staff are not adequately trained to take care of Clients
INVESTIGATION FINDINGS:
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On 1/7/2025 at 8:10AM Licensing Program Analyst (LPA) A Gomez arrived unannounced to deliver findings. LPA met with staff Debra Bates and explained the purpose of the visit. Staff contacted Administrator Shirley Jones and the administrator arrived at approximately 8:50AM.

On 12/12/2024 LPA visited the facility and observed that staff (S1) was up to date on trainings and knowledgable when questioned about best practices. LPA also observed the clients to be clean before going to the day program as well as their rooms and laundry.

REPORT CONTINUES ON LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
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-20241204140243
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: SHIRLEY'S CARE HOME
FACILITY NUMBER: 079200308
VISIT DATE: 02/07/2025
NARRATIVE
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On 1/10/2025 LPA conducted an unannounced collateral visit to observe C1 at the day program. C1 was observed to be clean and in clean clothes. On 2/7/2025 LPA observed all the clients clean and tidy before leaving for the day program. Therefore the allegations "Staff neglecting Clients in Care" and "Staff are not adequately trained to take care of Clients" is 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: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2