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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200603
Report Date: 01/22/2025
Date Signed: 04/02/2025 09:34:56 AM

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
12/27/2024 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20241227084412
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:
01/22/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Bernadette DuguanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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ILLEGAL EVICTION
STAFF TALK TO CLIENTS INAPPROPRIATELY
INVESTIGATION FINDINGS:
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On 4/2/2025 at 9:00 AM, Licensing Program Analysts (LPAs) A Gomez and J Clancy-Czuleger arrived unannounced to deliver amended findings of the complaint investigation in regard to the allegations above. LPAs met with Administrator, Bernadette Dugan and explained the purpose of the visit. At the time of amended report the facility had no clients.

On 12/31/2024 LPA's and AGPA reviewed records, interviewed clients, administrator, and toured facility. On 1/16/2025 LPA interviewed W1 over the phone.

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

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
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 4
Control Number 15-AS-20241227084412
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: 01/22/2025
NARRATIVE
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On the allegation “STAFF TALK TO CLIENTS INAPPROPRIATELY.” it was found during interviews that Administrator/ Licensee calls the clients "fat", “obese” and "disgraceful". Also, during the visit on 12/31/2024 LPA and AGPA observed the Licensee yelling at C2 when they did not answer a question the way they wanted them to. Client appeared scared and backed into the corner while the Licensee intimidated them and said they were lying as a response to C2’s answer. On the allegation “ILLEGAL EVICTION” it was found during interviews and a voicemail played to the department that the Administrator/ Licensee told the client that they couldn’t come back to the facility while away on a visit.

***A Civil Penalty in the Amount of $250 X 2 is being assessed for repeat violations within a 12 month period***

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: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20241227084412
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: 01/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/23/2025
Section Cited
CCR
80068.5(a)
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(a) Except for children's residential facilities, the licensee may, upon 30 days written notice to the client…following reasons:
This requirement was not met as evidenced by:
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By POC Licencee agrees to review the regulation and notify CCLD.
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Based on interviews and voicemail the Licensee did not comply with the section cited above by telling client in care that they could not come back to the facility which posed a potential personal rights violation to client 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: 01/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 15-AS-20241227084412
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: 01/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/27/2025
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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By POC Licencee agrees to review regualtion notify CCLD.
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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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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: 01/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4