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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201004
Report Date: 03/07/2023
Date Signed: 03/07/2023 01:31:53 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
12/19/2022 and conducted by Evaluator Laura Hall
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20221219153844
FACILITY NAME:BAKER'S HOMEFACILITY NUMBER:
079201004
ADMINISTRATOR:CRUZ, RONNEL DELAFACILITY TYPE:
735
ADDRESS:2214 BAKER CT.TELEPHONE:
(917) 750-5856
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:4CENSUS: 4DATE:
03/07/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jeffrey Meimban, CaregiverTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Staff hit resident while in care.

Staff dragged resident while in care.

Staff did not allow resident to use an electronic device.
INVESTIGATION FINDINGS:
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On 3/7/2023 at 1:00PM, Licensing Program Analysts (LPAs), L. Hall and Carol Fowler conducted and unannounced visit to deliver complaint findings for the above allegations. LPA met with Jeffrey Meimban, Caregiver, and explained the purpose of the visit.

During the course of the investigation, the Department conducted interviews with clients, staff, obtained and reviewed records. During interviews with S1 and S2 it was stated that C1 would fabricate stories to get what C1 wants. Staff stated a verbal altercation did occur, but no one hit C1 neither staff nor clients. Based on the investigation the above allegations are unsubstantiated.

Continued on LIC9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
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-20221219153844
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: BAKER'S HOME
FACILITY NUMBER: 079201004
VISIT DATE: 03/07/2023
NARRATIVE
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Continued from LIC9099.

On the allegation staff dragged resident while in care, C1 stated during interview that her teacher pushed her outside and then stated she did not want to discuss the incident. Based on record review of C1’s individual service plan (ISP), it indicates C1 can be hard to engage in a conversation if the topic is of no interest to her and will often shift her engagements to topics of her interest if she chooses to continue communication. S2 stated during interview that no one touched C2.

On the allegation Staff did not allow resident to use an electronic device, based on interview with S1 staff allows C1 to use the electronic device (iPad) whenever she request. S1 stated there is not any set time for the use of the iPad. S1 also stated the iPad is kept by staff for storage only because the iPad C1 had previously was lost. Interviews with staff and other client indicated that the physical altercation never occurred, therefore, losing the use of the iPad never occurred.

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



Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC9099 (FAS) - (06/04)
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