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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201030
Report Date: 02/12/2025
Date Signed: 02/12/2025 12:01:22 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
05/23/2024 and conducted by Evaluator Carol Fowler
COMPLAINT CONTROL NUMBER: 15-AS-20240523144302
FACILITY NAME:A&A HEALTH SERVICES SAN PABLOFACILITY NUMBER:
079201030
ADMINISTRATOR:RIDOLFI, ELEINA LFACILITY TYPE:
735
ADDRESS:13956 SAN PABLO AVETELEPHONE:
(510) 609-4040
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY:225CENSUS: 120DATE:
02/12/2025
UNANNOUNCEDTIME BEGAN:
10:27 AM
MET WITH:HEATHER PAYNE, CLIENT CARE DIRECTORTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Staff raped resident.
INVESTIGATION FINDINGS:
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On 02/12/2025 at 10:30am, Licensing Program Analyst (LPA), Carol Fowler arrived unannounced to deliver complaint findings for the allegation above. LPA met with Heather Payne, Client Care Director and explained the purpose of the visit.

The Department interviewed C1 on 5/16/2024 who stated being “telepathically” raped by S2. C1 stated having informed S1 that C1 had been raped by S2, but had not physically touched C1, C1 denied that S2 had harmed C1 and denied that S2 had raped C1. The Department found that when the facility staff was informed of the allegation, the local PD was contacted. The Department obtained the police report and found that on 6/13/2024 San Pablo Police Department (SPPD) met with C1 who stated again that S2 had raped C1 with S2’s eyes, that C1 had been raped and molested by 13 family members, had memories of

continue on LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
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-20240523144302
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: 02/12/2025
NARRATIVE
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continue from LIC 9099

being molested by a grandparent that continues to contact C1 telepathically to engage in sexual behaviors. The officer contacted C1’s case manager, who stated that C1 had not reported the alleged incident. On 9/19/24, the Department interviewed the Licensees who stated that C1 had reported to security that S2 had entered C1s room to assist a roommate but had telepathically made sexual contact with C1.

The Department has investigated this allegation and per information obtained, did not establish the factual accuracy of the alleged incident.

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

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2