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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200861
Report Date: 09/07/2023
Date Signed: 09/07/2023 01:10:01 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/30/2023 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230830103730
FACILITY NAME:GAENOR HOME INCFACILITY NUMBER:
079200861
ADMINISTRATOR:NORIEGA, DIONEILFACILITY TYPE:
735
ADDRESS:1754 SATTLER DRTELEPHONE:
(925) 332-7907
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:6CENSUS: 6DATE:
09/07/2023
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Ernesto Ortigas, StaffTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Staff installed an inappropriate door knob to prevent a client from wandering
INVESTIGATION FINDINGS:
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On 9/7/2023 at 11:10AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings regarding the allegation above. LPA met with staff, Ernesto Ortigas and informed him of the reason for the visit. LPA spoke with Administrator, Dioneil Noriega over the phone and stated staff can sign the reports.

During the course of investigation, LPA interviewed 2 clients and 2 staff. LPA reviewed and obtained client's physician's report. Interview with staff revealed that a child proof door knob cover was used on C6's door about a week ago. Staff stated that the child proof door knob cover have been removed.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted. A copy of this report and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
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-20230830103730
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: GAENOR HOME INC
FACILITY NUMBER: 079200861
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/08/2023
Section Cited
CCR
80072(a)(7)
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Personal Rights. Not to be locked in any room, building, or facility premises by day or night. This requirement is not met as evidence by:
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LPA observed that facility has removed the child proof door knob cover. Administrator has agreed to conduct an in-service training and submit staff sign in sheet and materials to CCLD by POC date.
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Based on investigation, licensee did not comply with the section cited above by using a child proof door knob cover which poses an immediate health and safety risk to the persons 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: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2