079201030-9-28-2023-15-AS-HHUL-CWRV8S-20231019161314

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201030
Report Date: 09/28/2023
Date Signed: 09/28/2023 01:14:27 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
04/07/2023 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20230407131038

FACILITY NAME:	A&A HEALTH SERVICES SAN PABLO		FACILITY NUMBER:	079201030
ADMINISTRATOR:	RIDOLFI, ELEINA L		FACILITY TYPE:	735
ADDRESS:	13956 SAN PABLO AVE		TELEPHONE:	(510) 609-4040
CITY:	SAN PABLO	STATE: CA	ZIP CODE:	94806
CAPACITY:	225	CENSUS: 125	DATE:	09/28/2023
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Raj Thandi, Program Director Kayla Sardenga, Resident Care Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Client sexually abused by another client while in care

INVESTIGATION FINDINGS:

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On 09/28/23 at 12:40PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit, met with resident care director (RCD) and spoke with program director (PD) on the phone who authorized RCD to act on her behalf and sign the reports. LPA explained the purpose of the visit with PD and RCD. LPA gathered information and delivered investigation findings to PD & RCD.

Allegation: Client sexually abused by another client while in care
Finding: Unsubstantiated
During investigation, the department obtained the following documents from administrator - staff roster, clients’ face sheets, admission agreements, physicians reports, clients’ roster, ID/Emergency information for 2 clients, house rules. Medication sheet, Progress notes, conservatorship documents, miscellaneous medical appointments.

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: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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-20230407131038

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: A&A HEALTH SERVICES SAN PABLO	FACILITY NUMBER: 079201030
	VISIT DATE: 09/28/2023

NARRATIVE

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During investigation, witness (W1) who is the client’s conservator stated that when C1 made her initial disclosure to police, she was exhibiting signs of being in a state of confusion and delirium due to her 5150 hold a few days prior. Police (W2) interviewed C1 who kept repeating that the intercourse between her and C2 was consensual and that C2 did not violate her.

Observations and interviews by the department matched C1’s statement with the police (W2) that her sexual relations with client #2 (C2) was consensual. C1 also stated that C2 was her boyfriend. Staff (S1, S2, S3, S4) stated they saw C1 around C2 but not in a sexual manner. S3 stated she observed C1 hold hands with C2 but she never heard C1 mention anything sexual going on between her and C2. Staff (ED, S3) stated that clients have the freedom to exit the facility at their own discretion, form intimate relationships and engage in sexual activity. Clients typically stay in their rooms or gather in common areas with fellow clients. Occasionally, they enter each other’s rooms. Due to their independence, clients can freely enter rooms and leave the facility. Staff intervene only to discourage room entry and guide them toward common areas like the living room or outdoor areas.

Based on records review, interviews conducted, and observations made, the department has investigated the above allegation that client was sexually abused by another client and found it to be unsubstantiated. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that client was sexually abused by another client while in care is unsubstantiated.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

LIC9099 (FAS) - (06/04)

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