079200916-4-1-2021-15-AS-KHOS-C2VHSB-20210510062649

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200916
Report Date: 04/01/2021
Date Signed: 04/01/2021 03:56:32 PM

Unsubstantiated

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
02/28/2020 and conducted by Evaluator Praveen Singh

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20200228140411

FACILITY NAME:	OUR HOME		FACILITY NUMBER:	079200916
ADMINISTRATOR:	BANSIL, REYNANTE		FACILITY TYPE:	735
ADDRESS:	9692 TAREYTON AVENUE		TELEPHONE:	(510) 220-6712
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94583
CAPACITY:	6	CENSUS: 5	DATE:	04/01/2021
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Reynante Bansil, Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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9

-Sexual Abuse

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Praveen Singh conducted this unannounced tele-visit with Administrator to deliver findings on the above allegation. Due to the present shelter in place order by the Governor, this inspection was conducted via video-conference.

The allegation of sexual abuse was accepted by the Department's Investigations Branch (IB) as a full investigation. The Department conducted interviews and reviewed records. Based on the investigation, there were no definitive facts or timeline to determine if C1 was sexually abused by facility staff or by C1’s adult day program staff. Due to C1’s developmental disabilities, C1 was unable to be successfully interviewed. San Ramon Police Department took DNA samples of facility staff and the beddings of the male clients. No DNA was detected on C1’s bedsheets.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided via email.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Julio Montes
LICENSING EVALUATOR NAME: Praveen Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 04/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2021

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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