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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200360
Report Date: 11/20/2024
Date Signed: 11/20/2024 04:22:19 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
12/15/2023 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20231215164208
FACILITY NAME:TELECARE HOPE HOUSEFACILITY NUMBER:
079200360
ADMINISTRATOR:GARCIA, DENISE GFACILITY TYPE:
772
ADDRESS:300 ILENE STREETTELEPHONE:
(925) 313-7980
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY:16CENSUS: 11DATE:
11/20/2024
UNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Clearnise Bullard, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not follow proper eviction procedures
INVESTIGATION FINDINGS:
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On 11/20/2024 at 2:55 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Administrator, Clearnise Bullard to deliver the findings of above allegation. LPA explained the purpose of the visit with Administrator.

During the investigation, the LPA obtained the following documents from the facility – Physician's Report (LIC602), Admission Form MHC(SC)-099A, Admission Agreement, Discharge - Disposition of Medications, Admission Nursing Screening, Telecare Hope House – Self Administration Record, Continued Stay Criteria Worksheet (12/1-12/7, 12/15-12/21), and House Rules.

LIC9099-C Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
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-20231215164208
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: TELECARE HOPE HOUSE
FACILITY NUMBER: 079200360
VISIT DATE: 11/20/2024
NARRATIVE
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LIC9099-C (Page 2)

Allegation: Staff did not follow proper eviction procedures
Finding: Unsubstantiated

During the investigation, the LPA conducted interviews of facility staff, witnesses, and reviewed resident (R1) documents. Interview with Witness (W1) stated that Client (C1) had a court appointed conservator and that the facility evicted C1 and did not give the eviction notice in writing to the conservator.

On 12/20/2023, the LPA interviewed W2 that stated C1 had a court appearance on 12/14/2023 and that the facility must have forgotten the appointment. W2 stated that C1 called his friend to come pick him up and take hm to his court appearance. W2 stated that C1 has a temporary state conservator, and that the conservator was not notified of the 3-day eviction. W2 stated that it would be the conservator to try to place C1 at a new facility

On 12/20/2023, the LPA interviewed Staff (S) S1-S4. S1 stated that there was not an eviction because C1 left on their own. S4 stated that C1 “self discharged” and that the court appearance was virtual; scheduled via Zoom. S4 stated that C1 went to the door and opened the door to let their friend into the facility. S4 stated that they heard loud voices, and they went to go check. S4 stated that the friend was acting aggressive and threatening staff. S4 stated that S2 called the county conservator but the conservator was on vacation. S4 stated that they spoke with “Conservator of the Day” to inform that they were going to start a 3-day eviction process when C1 left the facility. S1-S4 stated that C1 left the facility with their friend outside of visiting hours.



LIC9099-C Continued...
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20231215164208
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: TELECARE HOPE HOUSE
FACILITY NUMBER: 079200360
VISIT DATE: 11/20/2024
NARRATIVE
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LIC9099-C Continued (Page 3)

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.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3