079201007-6-14-2023-15-AS-KHOS-CSYHHX-20230620061329

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201007
Report Date: 06/14/2023
Date Signed: 06/14/2023 01:17:20 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
06/08/2023 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20230608143303

FACILITY NAME:	BELTRAN'S PLACE		FACILITY NUMBER:	079201007
ADMINISTRATOR:	RODRIGUEZ, RENE ELIAS		FACILITY TYPE:	735
ADDRESS:	4645 APPLEGLEN ST		TELEPHONE:	(904) 859-1773
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	6	CENSUS: 6	DATE:	06/14/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Rene Rodriguez, Administrator		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Staff smoked marijuana inside facility in the presence of clients
Staff stole resident's food
Staff spoke inappropriately to resident

INVESTIGATION FINDINGS:

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On 06/14/23 at 11:30PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with administrator (ADM), gathered information and delivered investigation findings of the above allegations. LPA explained the purpose of the visit with ADM.

Allegation: Staff smoked marijuana inside facility in the presence of clients
Investigation Finding: Unsubstantiated
During investigation, LPA toured the facility with administrator (ADM) including but not limited to 5 bedrooms, 2 ½ bathrooms, garage, living room, kitchen, dining room and backyard. LPA observed no marijuana smell in any of the areas inspected.
Continued on next page, LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

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-20230608143303

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: BELTRAN'S PLACE	FACILITY NUMBER: 079201007
	VISIT DATE: 06/14/2023

NARRATIVE

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Allegation: Staff smoked marijuana inside facility in the presence of clients
Investigation Finding: Unsubstantiated (Continuation)
Clients (C1, C2, C3) confirmed with LPA that they did not witness any staff or client smoke marijuana in their presence at the facility. LPA interviewed staff (ADM, S1, S2, S3) who denied smoking marijuana inside or outside the facility in the presence of clients. 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 that staff smoked marijuana inside facility in the presence of clients is unsubstantiated.

Allegation: Staff stole resident’s food
Investigation Finding: Unsubstantiated
During investigation, clients (C1, C2, C3) confirmed with LPA that staff do not steal their food at the facility. Clients stated are able to eat food given by family & friends or food that they purchase outside. Clients also stated staff provides sufficient daily breakfast, lunch, dinner, snacks and drinks to them. 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 that staff stole resident's food is unsubstantiated.

Allegation: Staff spoke inappropriately to resident
Investigation Finding: Unsubstantiated
During investigation, clients (C1, C2, C3) confirmed with LPA that staff (ADM, S1, S2, S3) do not yell, swear, threaten or verbally abuse them. Staff stated they treat all clients with dignity and respect. Clients (C1, C2, C3) stated staff treat them well and do not abuse them verbally or physically. LPA observed staff not using any swear words when talking with clients. 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 that staff spoke inappropriately to resident is unsubstantiated.

Exit Interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

LIC9099 (FAS) - (06/04)

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