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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200603
Report Date: 08/07/2024
Date Signed: 08/07/2024 05:17:42 PM

Substantiated


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
07/08/2024 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20240708085122
FACILITY NAME:OUR HOMEFACILITY NUMBER:
079200603
ADMINISTRATOR:DUGAN, BERNADETTEFACILITY TYPE:
735
ADDRESS:370 VERNAL DRIVETELEPHONE:
(925) 933-8706
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 2DATE:
08/07/2024
ANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Licensee, Bernadette DuganTIME COMPLETED:
05:25 PM
ALLEGATION(S):
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Staff does not ensure a safe environment is provided to clients in care
Staff does not ensure clients receive meals in a timely manner
Staff speaks inappropriately to clients in care
Staff does not ensure clients are provided copies of their admission agreements
INVESTIGATION FINDINGS:
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On 8/07/2024 at 11:40 PM, Licensing Program Analysts (LPAs) A Gomez and J Clancy-Czuleger arrived unannounced to deliver findings of the complaint investigation in regard to the allegations above. LPAs met with Administrator, Bernadette Dugan and explained the purpose of the visit.

During the course of the investigation LPA's obtained records, interviewed clients, administrator, responsible parties, and case manager at RCEB. LPA's also toured facility.

On the allegation that staff speaks inapprpriatley to clients in care it was found during interviews that Administrator called the client a "terrible person" and a "hoarder". On the allegation that staff does not ensure clients receive meals in a timely manner it was found during interviews that the administrator has fed them late at approximately 10pm on several occasions.

Report continues on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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 5
Control Number 15-AS-20240708085122
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: OUR HOME
FACILITY NUMBER: 079200603
VISIT DATE: 08/07/2024
NARRATIVE
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On the allegation that staff did not provide clients a copy of their admissions agreement it was found during file review and interview that an admission agreement was not provided to clients. On the allegation that Staff does not ensure a safe environment is provided to clients in care during interviews and observations it was found that Administrator was not informed on the clients needs and diagnosis because Administrator did not know how to get into their email to review the clients Pre-admissions packets and thereby was not able to provide the clients with the care that they needed.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
07/08/2024 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20240708085122

FACILITY NAME:OUR HOMEFACILITY NUMBER:
079200603
ADMINISTRATOR:DUGAN, BERNADETTEFACILITY TYPE:
735
ADDRESS:370 VERNAL DRIVETELEPHONE:
(925) 933-8706
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 2DATE:
08/07/2024
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Licensee, Bernadette DuganTIME COMPLETED:
05:25 PM
ALLEGATION(S):
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Staff disposed of clients personal property as a form of punishment
INVESTIGATION FINDINGS:
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On 8/07/2024 at 11:40 PM, Licensing Program Analysts (LPAs) A Gomez and J Clancy-Czuleger arrived unannounced to deliver findings of the complaint investigation in regard to the allegations above. LPAs met with Administrator, Bernadette Dugan and explained the purpose of the visit.

During the course of the investigation LPA's obtained records, interviewed clients, administrator, responsible parties, and case manager at RCEB. LPA's also toured facility. LPA's were unable to confirm if clients personal property was disposed of.

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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20240708085122
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: OUR HOME
FACILITY NUMBER: 079200603
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/20/2024
Section Cited
CCR
80065(a)
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(a)Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.
This requirement is not met as evidence by:
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Mandatory Meeting will be held at a later date
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Based on observations and interviews the licensee did not comply with the section above by not knowing how to access client information to be able to provide the proper care which posed a potential health and safety risk to clients in care
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Type B
08/20/2024
Section Cited
CCR
80068(g)(1)
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(g) The licensee shall retain in the client's file the original of the initial admission agreement and all subsequent modifications.(1)The licensee shall provide a copy of the current admission agreement to the client and the client's authorized representative, if any.
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Mandatory Meeting will be held at a later date
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Based on record reviews and interviews the licensee did not comply with the section sited above by not providing admissions agreements to clients in care which posed a potential personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20240708085122
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: OUR HOME
FACILITY NUMBER: 079200603
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/20/2024
Section Cited
CCR
80072(a)(3)
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(a) Except for children’s residential facilities, each client shall have personal rights which include... (3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion... to physical functioning.
This requirement is not met as evidence by:
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Mandatory Meeting will be held at a later date
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Based on interviews and documentation received the licensee did not comply with the section cited above by speaking inappropriately to clients in care which posed an immediate personal rights risk to clients in care.
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Type A
08/20/2024
Section Cited
CCR
80076(a)(2)
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(a)In facilities providing meals to clients, the following shall apply: ( 2)Where all food is provided by the facility, arrangements shall be made so that each client has available at least three meals per day.
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Licensee agrees to provide 3 meals a day and to create a weekly menu that is agreed upon by clients and staff, additionally Mandatory Meeting will be held at a later date
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Based on interviews and document review the licensee did not comply by not providing three meals a day which posed an immediate health and personal rights risk to clients in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5