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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200764
Report Date: 11/06/2025
Date Signed: 11/06/2025 11:15:09 AM

Substantiated


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
10/23/2025 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20251023125033
FACILITY NAME:NEEMA HAVEN HOMEFACILITY NUMBER:
079200764
ADMINISTRATOR:NDEFUNGO, GOODLUCKFACILITY TYPE:
735
ADDRESS:434 RODRIGUES AVENUETELEPHONE:
(925) 335-6428
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY:6CENSUS: 1DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Goodluck Ndefungo, Licensee/AdministratorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff does not ensure clients are spoken to in an appropriate manner
INVESTIGATION FINDINGS:
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On 11/06/2025 at 9:55 AM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Direct Support Staff, Stella Mushi, to deliver findings regarding the above allegation. Stella phoned, Licensee/Administrator, Goodluck Ndefungo, to inform LPA's presence. LPA spoke with Goodluck on the phone and explained the purpose of the visit. Goodluck Ndefungo arrived at 10:50 AM.

During the course of the investigation, the Department conducted interviews with witnesses (W), staff (S), and clients (C), and reviewed relevant documentation and video evidence.

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

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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-20251023125033
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: NEEMA HAVEN HOME
FACILITY NUMBER: 079200764
VISIT DATE: 11/06/2025
NARRATIVE
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LIC9099-C (Page 2)

Allegation: Staff does not ensure clients are spoken to in an appropriate manner.
Finding: SUBSTANTIATED

On 10/24/2025, LPA interviewed Witness 1 (W1) who stated they observed a video showing a staff member at the facility calling Client 1 (C1) an inappropriate name. W1 reported that C1 was in the kitchen cooking their food and had accidentally recorded the interaction with staff.

On 10/27/2025, LPA interviewed S1 who confirmed that the staff involved in the incident was S2. S1 stated they had viewed the video sent to them by C1 and were on the phone during part of the altercation. S1 reported hearing an argument between C1 and S2 regarding food taken from the refrigerator. S1 stated they previously reminded S2 to remain professional when addressing clients.

On 10/27/2025, LPA interviewed C1 who stated the incident occurred on 10/17/2025. C1 reported being in the kitchen cooking their food when S2 told them they could not cook all of the food taken out of the refrigerator. C1 stated they only intended to cook enough for themselves and wasn’t planning to cook all of the food, but that S2 continued to “nitpick” and made personal remarks about their past. C1 admitted responding with an inappropriate comment toward S2, after which S2 used inappropriate language toward them.

On 10/28/2025, LPA interviewed S2 who admitted to being the person in the video and confirmed making the statements heard. S2 stated that at approximately 4:30 PM, C1 came downstairs and removed multiple frozen food items from the freezer. S2 reported telling C1 not to cook all of the food, at which point C1 began yelling and calling S2 derogatory names. S2 stated they became frustrated and retaliated by calling C1 the same derogatory names.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20251023125033
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: NEEMA HAVEN HOME
FACILITY NUMBER: 079200764
VISIT DATE: 11/06/2025
NARRATIVE
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LIC9099-C (Page 3)

On 10/29/2025, LPA interviewed S3 who stated they were aware of the incident and had also seen the video. S3 reported that C1 often removes large quantities of food, places it in the sink, and sometimes wastes the food by discarding it later. S3 described C1 as being difficult to redirect when upset.

Based on LPA’s observations, interviews conducted, and review of the video evidence, the preponderance of evidence standard has been met. The allegation that staff does not ensure clients are spoken to in an appropriate manner is therefore found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC-9099D.

An exit interview was conducted, and a copy of this report, LIC 9099D and appeal rights was provided to the Administrator.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 15-AS-20251023125033
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: NEEMA HAVEN HOME
FACILITY NUMBER: 079200764
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2025
Section Cited
CCR
80072(a)(1)
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CCR 80072(a)(1) – Personal Rights ...each client shall have personal rights which include, but are not limited to, the following:
(1) To be accorded dignity in his/her personal relationships with staff and other persons.



This requirement is not met as evidenced by:
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Administrator agreed to conduct training at a minimum of 4 hours with all Direct Support Staff in Personal Rights and Professional Conduct/Communication to ensure staff interact respectfully and appropriately with clients at all times including but not limited
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Based on interviews, record reviews and observation of video evidence, the Licensee did not comply with the section cited above when S2 was observed calling a client (C1) an inappropriate name during a verbal altercation, which poses a potential health, safety or personal rights risk to persons in care.
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to behaviors, mental health and person centered practices with an approved CCLD vendor. Administrator will submit transcripts/certificates to CCLD by POC due date.
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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: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4