079201101-3-27-2024-15-AS-KHOS-D46LDA-20240409083938

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201101
Report Date: 03/27/2024
Date Signed: 03/27/2024 12:53:55 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
12/21/2023 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20231221121935

FACILITY NAME:	ELIAS PLACE		FACILITY NUMBER:	079201101
ADMINISTRATOR:	RODRIGUEZ, RENE		FACILITY TYPE:	735
ADDRESS:	2355 GLENDALE CIR		TELEPHONE:	(925) 978-4342
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	6	CENSUS: 5	DATE:	03/27/2024
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Aimee De La Fuente Uri, Direct Support Professional		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility staff physically restrained resident.

Facility staff spoke inappropriately to resident.

Facility staff made inappropriate gestures towards resident.

Facility staff did not make hazardous items inaccessible.

INVESTIGATION FINDINGS:

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On 3/27/2023 at 11:50am, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint findings for the allegations above. LPA met with Aimee De La Fuente Uri, Direct Support Professional and explained the reason for the visit. Administrator, Rene Rodriguez, arrived at 12:15pm.

During the course of the investigation LPA interview staff, Reporting Party (RP), Clients obtained and reviewed records.

Allegation: Facility staff physically restrained resident.

Reporting party stated during interview that staff physically restrained clients. Based

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

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-20231221121935

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: 03/27/2024

NARRATIVE

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Continued from LIC9099.

on interviews with staff it was stated they are not allowed to put clients in a hold. S1 stated if a client needs to be restrained as a last resort the staff would use ProAct training, but the staff have not had to use that procedure. S2 and S3 stated they can protect themselves if the client is having a behavior, but not restrain, and they have to contact S1.

Allegation: Facility staff spoke inappropriately to resident.

Based on interviews with staff and clients the staff do not speak inappropriately to the clients. S1 stated he have not been notified or observed any inappropriate behavior from staff towards clients. C1 and C2 stated that the staff treats everyone the same.

Allegation: Facility staff made inappropriate gestures towards resident.

Based on interviews with clients one (1) stated that facility staff made inappropriate gestures by shaking her backside in front of the client but could not give a name. The other clients stated no inappropriate gestures were made. Staff stated during interviews that no inappropriate gestures were made toward clients. S1 stated he has not been notified or observed any inappropriate gestures made by staff to clients.

Continued on LIC9099C.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20231221121935

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: 03/27/2024

NARRATIVE

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Continued from LIC9099C.

Allegation: Facility staff did not make hazardous items inaccessible.

RP stated during interview that one client uses items to harm thyself. Based on interview with S1 there is a client that will use just about anything to harm himself, but all hazardous items are always locked. If that client is having a crisis any objects staff feel can be used are quickly put away until the crisis is over.

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: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

LIC9099 (FAS) - (06/04)

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