<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200990
Report Date: 10/19/2023
Date Signed: 10/19/2023 04:14:24 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
10/16/2023 and conducted by Evaluator James Sampair
COMPLAINT CONTROL NUMBER: 15-AS-20231016094521
FACILITY NAME:B & B RESIDENTIAL CARE HOMEFACILITY NUMBER:
079200990
ADMINISTRATOR:CHERYL SMITHFACILITY TYPE:
735
ADDRESS:320 RIPLEY AVETELEPHONE:
(707) 332-5920
CITY:RICHMONDSTATE: CAZIP CODE:
94801
CAPACITY:4CENSUS: 2DATE:
10/19/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Caregiver Adraine TrappsTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent resident from being physically abused
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/19/2023 at 09:15 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct the initial 10-day complaint investigation of the allegation above. Upon entry, LPA informed Caregivers Maria Benitez and Adraine Trapps. Licensee Cheryl Smith was then informed by phone of the purpose of the visit.

Over the course of this investigation, LPA reviewed facility and client records, and interviewed 2 clients, 2 staff members, 3 witnesses, and the Licensee.

Allegation: Staff did not prevent resident from being physically abused.
Based on the records review, interviews with the client, witnesses, staff, and Licensee, there was no evidence that the client has been physically abused.

(Continued on LIC9099-C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
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-20231016094521
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: B & B RESIDENTIAL CARE HOME
FACILITY NUMBER: 079200990
VISIT DATE: 10/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(...Continued from LIC9099)

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

Exit interview was conducted with Caregiver Adraine Trapps. A copy of this report was provided via email to the Licensee.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2