079200787-1-24-2024-15-AS-KHOS-CZXM98-20240129082418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200787
Report Date: 01/24/2024
Date Signed: 01/24/2024 11:30:42 AM

Unfounded

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
01/17/2024 and conducted by Evaluator James Sampair

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20240117134508

FACILITY NAME:	DIANA'S CARE HOME		FACILITY NUMBER:	079200787
ADMINISTRATOR:	REANO-AQUINO, GRACE		FACILITY TYPE:	740
ADDRESS:	27402 MANON AVENUE		TELEPHONE:	(510) 786-9982
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY:	35	CENSUS: 35	DATE:	01/24/2024
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Administrator Grace Reano-Aquino		TIME COMPLETED:	11:55 AM

ALLEGATION(S):

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Staff did not safeguard resident's cash resources

INVESTIGATION FINDINGS:

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On 1/24/2024 at 09:05 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct the initial 10-day complaint inspection of the facility pertaining to the allegation above. Upon arrival, LPA stated the purpose of the visit to Administrator Grace Reano-Aquino.

The complainant alleged that the staff did not safeguard resident's cash resources. The complaint concerned Resident R1. The LPA interviewed R1, who stated, "from April to November 2023, I saw nothing." The LPA reviewed R1's financial records. During the record review, the LPA observed R1's signed receipts confirming that they had received all of the monies they were supposed to have received, disproving R1's claim that they had not received any cash between April and November 2023.

The allegation is false, could not have happened, and/or is without a reasonable basis, therefore, the allegation is UNFOUNDED.

Exit interview conducted and a copy of this report provided for Administrator via email.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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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