079200563-4-30-2025-15-AS-KHOS-DH3KBH-20250527074533

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200563
Report Date: 04/30/2025
Date Signed: 04/30/2025 12:56:39 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
04/11/2025 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20250411104008

FACILITY NAME:	MISSION-HOPE DAY PROGRAM-ANTIOCH		FACILITY NUMBER:	079200563
ADMINISTRATOR:	GAMEZ, JUANITA NIMFA Y		FACILITY TYPE:	775
ADDRESS:	10 SOUTH LAKE DRIVE		TELEPHONE:	(925) 706-7517
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	49	CENSUS: 32	DATE:	04/30/2025
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Mitizi Wardini, Program Director		TIME COMPLETED:	01:05 PM

ALLEGATION(S):

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Staff did not intervene when clients engaged in physical altercations

Staff left client unattended

INVESTIGATION FINDINGS:

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On 4/30/2025, at 12:45pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint findings for the allegations above. LPA met with Mitzi Wardini, Program Director, and explained the reason for the visit.

During the investigation LPA interviewed staff, witness, reviewed and obtained records.

Allegation: Staff did not intervene when clients engaged in physical altercations
W1 received email stating that staff did not intervene when clients engage in physical altercations. S4 was interviewed on April 24, 2025. S4 stated that she was in the van with C1 and C1 was saying “stop” and crying. C2 came to get in the van and threw a backpack at C1. The backpack hit C1 in the forehead. S4 observed blood coming from

Continued on LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20250411104008

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: MISSION-HOPE DAY PROGRAM-ANTIOCH	FACILITY NUMBER: 079200563
	VISIT DATE: 04/30/2025

NARRATIVE

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Continued from LIC9099.

C1’s forehead and called for help. S6 came and escorted C2 out of the van. S4 took C1 back into the facility to apply first aid. S1 stated the clients were separated immediately by S4 and S6. S1 further stated clients were taken home in separate vehicles.

Allegation: Staff left client unattended

W1 received email stating that C1 was left unattended at the day program. During interview W1 stated all information given is second-hand. During interviews with S1 and S3 it was stated that the clients are never left unattended. Clients can roam the facility alone. S1 stated the clients are assigned to a staff member in groups of three and there are not any clients that require 1:1 supervision that attends the program. LPA reviewed staff schedules as well as bus/van schedules, all show ratio staff to client is met.

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: Laura Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2025

LIC9099 (FAS) - (06/04)

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