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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200856
Report Date: 11/05/2024
Date Signed: 11/05/2024 11:51:10 AM

Unsubstantiated


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
08/26/2024 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240826160246
FACILITY NAME:CYPRESS HOUSEFACILITY NUMBER:
079200856
ADMINISTRATOR:JOSEPH, CRYSTALYNFACILITY TYPE:
738
ADDRESS:24 W. CYPRESS PLACETELEPHONE:
(925) 392-0282
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:4CENSUS: 4DATE:
11/05/2024
UNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Crystalyn Joseph, AdministratorTIME COMPLETED:
01:03 PM
ALLEGATION(S):
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Staff unlawfully evicted a client
INVESTIGATION FINDINGS:
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On 11/05/2024 at 10:41AM, Licensing Program Analyst (LPA), Tonica Syess-Gibson arrived unannounced to deliver complaint findings for the allegation above. LPA met with Crystalyn Joseph, Administrator, and explained the reason for the visit.

During the investigation, LPA T. Syess-Gibson interviewed three (3) staff members and complainant. LPA reviewed and obtained documents including clients discharge summary reports, Physician’s report, IPP and incident reports for the month of August 2024. All three (3) staff members stated C1 is still a client at the facility however, C1 is currently admitted to Sutter Delta Medical Center for treatment and observation after having a grand mal seizure.

Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
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 2
Control Number 15-AS-20240826160246
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: CYPRESS HOUSE
FACILITY NUMBER: 079200856
VISIT DATE: 11/05/2024
NARRATIVE
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Continued from LIC9099

Staff unlawfully evicted a client.
Interview with complainant revealed Cypress House/Telecare staff hasn’t picked C1 up from the medical center after being discharged on 08/13/2024. Sutter Delta Medical Center has offered to send C1 back with a rescue inhaler to help with seizures.

Interview with three (3) staff members revealed that C1 currently resides at the facility and is currently admitted to Sutter Delta Medical Center for treatment and observation due to grand mal seizures. Staff explained that Sutter Delta Medical Center wants to release C1 back to the facility with an rescue inhaler to administer the medications needed for seizures. Telecare has requested that medication be prescribed for oral consumption before C1 is released back to Cypress House. On 10/15/2024 LPA spoke with Crystalyn Joseph, Administrator who informed LPA of client being back into the community as of 09/11/2024.

Based upon the information obtained during investigation, the above allegation 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 this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2