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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200965
Report Date: 02/20/2025
Date Signed: 02/20/2025 04:53:31 PM

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
02/14/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250214153917
FACILITY NAME:J AND R HOME CARE LLCFACILITY NUMBER:
079200965
ADMINISTRATOR:TANG, RENEEFACILITY TYPE:
735
ADDRESS:773 SARAH STREETTELEPHONE:
(925) 634-8863
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:5CENSUS: 4DATE:
02/20/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Eliza Capio, Direct Care StaffTIME COMPLETED:
05:07 PM
ALLEGATION(S):
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Facility staff was intoxicated and gave resident marijuana.
INVESTIGATION FINDINGS:
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On 02/20/2025 at 9:50AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct complaint investigation and to deliver complaint findings for the allegations above. LPA met with Direct care staff, Eliza Capio and explained the purpose of the visit. Eliza called House Manager, Joy Bisaha who arrived at 10:23AM, LPA explained the purpose of visit.

During the course of the investigation, LPA T. Syess-Gibson conducted interviews with 3 clients, 1 client refused to talk to LPA, 2 staff, and complainant. LPA also reviewed and obtained documents including facility's investigation notes, client roster, staff schedule, clients physician reports , pre placement appraisal, individual program plan agreement, IPP, and Dangerous Propensity.

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

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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-20250214153917
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: J AND R HOME CARE LLC
FACILITY NUMBER: 079200965
VISIT DATE: 02/20/2025
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Continue from LIC9099


Allegation: Facility staff was intoxicated and gave resident marijuana

Interview with staff and clients revealed that staff was not intoxicated and did not give clients marijuana. Clients stated during interviews, staff hasn't offered clients marijuana and isn't aware of any staff being intoxicated. Staff stated during interview, facility conducted their own investigation and was informed by staff and clients that marijuana was not offered to clients in care and staff was not observed to be intoxicated.

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

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2