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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201101
Report Date: 07/14/2022
Date Signed: 07/14/2022 01:03:28 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
07/08/2022 and conducted by Evaluator Laura Hall
COMPLAINT CONTROL NUMBER: 15-AS-20220708121700
FACILITY NAME:ELIAS PLACEFACILITY NUMBER:
079201101
ADMINISTRATOR:RODRIGUEZ, RENEFACILITY TYPE:
735
ADDRESS:2355 GLENDALE CIRTELEPHONE:
(904) 859-1773
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:6CENSUS: 4DATE:
07/14/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rene Rodriguez, AdministratorTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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9
Staff not providing comfortable sleeping environment for resident.

Staff did not ensure resident is transported to appointments.
INVESTIGATION FINDINGS:
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5
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9
10
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13
On 7/24/2022 at 11:00AM, Licensing Program Analyst (LPA), L. Hall arrived unannounced to conduct a complaint investigation and to deliver complaint findings for the above allegations. LPA met with Rene Rodriguez, Administrator, and explained the reason for the visit.

During the course of the investigation, LPA interviewed staff and three (3) of four (4) clients. LPA requested the following documents facility and staff roster to be sent to CCLD no later than 7/21/2022 on the allegation staff not providing comfortable sleeping environment for resident, interview with S1 and S2 stated that C1 did sleep in the garage for two (2) days, however, it was to keep C1 in a safe environment. C1 had an incident with C5 and C1 needed to be kept away from C5. C1 stated he slept in the garage for 1 night and felt safe there.

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

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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-20220708121700
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: ELIAS PLACE
FACILITY NUMBER: 079201101
VISIT DATE: 07/14/2022
NARRATIVE
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Continued from LIC9099.

On the allegation staff did not ensure resident is transported to appointments. Interviews with clients and staff indicated that either S1 or S2 transport clients to appointments and outings.

Based upon interviews during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

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

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2