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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201043
Report Date: 08/24/2023
Date Signed: 08/24/2023 05:12:39 PM

Substantiated


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
08/14/2023 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20230814171809
FACILITY NAME:D + V ENHANCEMENT SERVICESFACILITY NUMBER:
079201043
ADMINISTRATOR:TING, VICKY S.FACILITY TYPE:
775
ADDRESS:4851-B LONE TREE WAYTELEPHONE:
(925) 813-1979
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:50CENSUS: 28DATE:
08/24/2023
UNANNOUNCEDTIME BEGAN:
04:13 PM
MET WITH:Olive Tapdasan, ADP Program ManagerTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff member engaged in inappropriate behavior with client in care
INVESTIGATION FINDINGS:
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On 08/24/23 at 4:13PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with staff (ADM, PD, S1), gathered information and delivered investigation finding. LPA explained the purpose of the visit with staff.

Allegation: Staff member engaged in inappropriate behavior with client in care
Finding: Substantiated
During investigation, LPA confirmed with staff (PD, S1) that the incident on 08/09/23 occurred inside the facility wherein client (C1) felt uncomfortable when one of the staff (S2) placed a banana next to his groin and told C1 to take a look on her way to the restroom. S1 assisted C1 to the restroom and confirmed with LPA that the incident happened. S1 told C1 to ignore S2 and that he was just joking. Continued on next page, LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
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 3
Control Number 15-AS-20230814171809
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: D + V ENHANCEMENT SERVICES
FACILITY NUMBER: 079201043
VISIT DATE: 08/24/2023
NARRATIVE
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The department has investigated the allegation that staff member engaged in inappropriate behavior with client in care. The preponderance of evidence standard has been met and the above allegation(s) was found to be substantiated.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.



Exit interview conducted. Appeal rights and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20230814171809
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: D + V ENHANCEMENT SERVICES
FACILITY NUMBER: 079201043
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2023
Section Cited
CCR
80072(a)(1)
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Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(1) To be accorded dignity in his/her personal relationships with staff and other persons.
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By POC due date, administrator agreed to complete and submit to CCL in-service staff retraining and certifcation on clients' personal rights in compliance with Title 22 Section 80072 regulations.
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This requirement was not met as evidenced by staff engaging in inappropriate behavior with client in care which posed a potential health & safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3