079200965-7-21-2023-15-AS-YFLS-CUZN5X-20230824101012

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200965
Report Date: 07/21/2023
Date Signed: 07/21/2023 03:15:19 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
10/28/2022 and conducted by Evaluator Lisha Holmes

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20221028085806

FACILITY NAME:	J AND R HOME CARE LLC		FACILITY NUMBER:	079200965
ADMINISTRATOR:	TANG, RENEE		FACILITY TYPE:	735
ADDRESS:	773 SARAH STREET		TELEPHONE:	(925) 895-0756
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	5	CENSUS: 2	DATE:	07/21/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Joy Bisaha, Care Staff		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Facility staff interacted in an inappropriate sexual manner with resident.

INVESTIGATION FINDINGS:

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On 07/21/23 around 2:45 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver the finding for the above allegation and close the complaint. LPA explained the purpose of the visit and met with Joy Bisaha, Care Staff.

Allegation: Facility staff interacted in an inappropriate sexual manner with resident.

During the investigation, the Department obtained documents (admission agreement, physician's report, client notes, individual program plan (IPP), emergency contact information for three (3) clients, and requested documents (LIC 500, LIC 501, and staff list with contact information).

...continued on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

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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Control Number 15-AS-20221028085806

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: J AND R HOME CARE LLC	FACILITY NUMBER: 079200965
	VISIT DATE: 07/21/2023

NARRATIVE

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...continued from LIC 9099

Based on interviews and records reviewed by the Department, there is not a preponderance of evidence to prove that S3 interacted in an inappropriate sexual manner with Client #1 (C1).

Observations and interviews with C1 revealed that C1 had difficulty answering detailed questions. W5 interjected questioning during the police interview with C1. W5 stated when he/she arrived at the facility on 10/24/22; the door was found locked which was odd to W5. S1 stated that C3 compulsively locks the facility doors during the day. S2 stated, “The front door to the facility stays unlocked during the day but it is locked at nighttime and sometimes the clients lock the door to their own room”. S3 stated, “The facility typically stays unlocked during the day.” C2 and S4 stated that C3 does lock doors which would explain why the front door was possibly locked when W5 arrived. S2 has never heard of anyone complaining about S1. C2 stated he/she doesn’t believe S1 touched C1 and that C1 is telling the truth. S4 stated, “…sexually assaulting C1 would be very different from who S1 is”. C3 said he/she has never been touched inappropriately by a staff member and has not seen another client touched inappropriately.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided to Joy Bisaha, Care Staff.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

LIC9099 (FAS) - (06/04)

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