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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201221
Report Date: 01/03/2025
Date Signed: 01/03/2025 12:42:24 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
03/07/2024 and conducted by Evaluator Laura Hall
COMPLAINT CONTROL NUMBER: 15-AS-20240307100309
FACILITY NAME:G & O RESIDENTIAL INC.FACILITY NUMBER:
079201221
ADMINISTRATOR:LOIDA GAVILANFACILITY TYPE:
735
ADDRESS:1500 CAJON CTTELEPHONE:
(925) 565-5731
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:4CENSUS: 4DATE:
01/03/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Angel Ramos Loera, Direct Care SupportTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility is retaining a resident with a higher level of care needs.
INVESTIGATION FINDINGS:
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On 1/3/2025 at 10:10am, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint finding for the allegation above. LPA met with Angel Ramos Loera, Direct Care Support and explained the reason for the visit. Licensee, Gabriela Gonzalez, arrived at 10:25am.

During the course of the investigation the Department conducted interviews with staff, witnesses, client, and obtained and reviewed records.

Allegation: Facility is retaining a resident with a higher level of care needs.

Based on initial interview W3 feels C1 requires a higher level of care due diagnosis. Witnesses stated that C1 is not able to perform testing needed for diagnosis and feels staff is not trained. Per regulation 80092.8 requires the client to be able to able to

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

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
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 7
Control Number 15-AS-20240307100309
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: G & O RESIDENTIAL INC.
FACILITY NUMBER: 079201221
VISIT DATE: 01/03/2025
NARRATIVE
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Continued from LIC9099.

administer and perform own medication and testing. S1, S2, and S4 stated during interviews that C1 performs own testing, and S1 stated C1 does not have to administer medication for the diagnosis. During interview with C1 he stated S4 and S6 had performed testing for him and that he is not able to do it.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (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. A copy of the appeal rights and this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 15-AS-20240307100309
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: G & O RESIDENTIAL INC.
FACILITY NUMBER: 079201221
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2025
Section Cited
CCR
80092.8(a)(2)
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(a) A licensee... may accept or retain a client who has diabetes... (2) The client is mentally and physically capable of administering his/her own medication and performing his/her own glucose testing... This requirement was not met as evidence by:
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Administrator agreed to impement a plan on how the facility will meet C1's needs for administering medication and performing testing, and submit plan to CCLD by POC date.
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Based on interviews and record review the Licensee did not comply with the section cited above in retaining client that can administer own testing, which poses a potential health and safety risk to persons 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: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
03/07/2024 and conducted by Evaluator Laura Hall
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240307100309

FACILITY NAME:G & O RESIDENTIAL INC.FACILITY NUMBER:
079201221
ADMINISTRATOR:LOIDA GAVILANFACILITY TYPE:
735
ADDRESS:1500 CAJON CTTELEPHONE:
(925) 565-5731
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:4CENSUS: DATE:
01/03/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Angel Ramos Loera, Direct Care SupportTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff refuse to provide water to resident.
Facility does not have enough staff to address resident's fall risk.
Staff member is emotionally abusing resident.
Staff discriminate against resident.
Staff are not adequately trained to provide care to resident(s).
Food services are inadequate.
Staff are not reporting incidents involving resident as required.
INVESTIGATION FINDINGS:
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*LPA amended report to add allegation to box above*

On 1/3/2025 at 10:10am, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint findings for the allegations above. LPA met with
Angel Ramos Loera, Direct Care Support and explained the reason for the visit. Licensee, Gabriela Gonzalez, arrived at 10:25am.

During the course of the investigation the Department conducted interviews with staff, witnesses, client, and obtained and reviewed records.

Allegation: Staff refuse to provide water to resident.

Based on interview with W3 the facility refused to give water to C1 after a certain time at night. S1 stated water and food is not cut off, but staff do monitor what is given at

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

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 15-AS-20240307100309
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: G & O RESIDENTIAL INC.
FACILITY NUMBER: 079201221
VISIT DATE: 01/03/2025
NARRATIVE
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Continued from LIC9099.

night. S1 also stated C1 keeps water in room at night if needed.

Allegation: Facility does not have enough staff to address resident's fall risk.

Based on interview the facility does not have enough staff because there should be two (2) people to assist C1 when he falls. LPA reviewed facility’s personnel report (LIC500) and observed there are three (3) staff at staggered times during the week and one (1) staff at night. During visit LPA observed three (3) staff present. During record review of C1's IPP dated 5/14/2021, it indicates that C1 is a fall risk, but does not indicate that additional staff is needed for support. S1 stated facility make sure staff is sufficient daily.

Allegation: Staff member is emotionally abusing resident.

Based on interview the facility staff is emotionally abusing resident by saying things in an abusive way and teasing him inappropriately. W3 stated during interview C1 was told his iPad would be taken if he keeps calling his family and snitching. W2 stated during interview that S2 will tell C1 she'll take him on a field trip, but if C1 doesn't do something he is supposed to do she won't take him. W2 stated that C1 takes everything personal. All staff stated during interviews that they had not or observed any staff abusing clients in any way.

Allegation: Staff discriminate against resident.

W3 stated during interview staff discriminates against C1 by not taking him on outings and has even told him he can't go because he is in a wheelchair. S1 stated

Continued on LIC9099C.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 15-AS-20240307100309
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: G & O RESIDENTIAL INC.
FACILITY NUMBER: 079201221
VISIT DATE: 01/03/2025
NARRATIVE
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Continued from LIC9099C

he bought a van with a ramp to take C1 on outings. C1 stated during interview that he goes on outings to the movies, zoo, and sometimes to the store.

Allegation: Staff are not adequately trained to provide care to resident(s).

During interview with W1 staff does not appear to be trained for diabetics. W2 stated the facility does not have enough staff and no training. LPA reviewed records for S2, S4, S5, and S6 and observed annual training was conducted for all four (4) staff.

Allegation: Food services are inadequate.

Based on interviews from witnesses the facility feed clients the same foods every day. LPA toured kitchen and observed a variety of frozen, canned, and fresh foods. LPA obtained and reviewed the food menu for the week 3/3/2024 – 3/9/2024 and 3/10/2024 – 3/16/2024, which showed a variety of foods were to be served. S1 stated that sometimes the staff will purchase foods from a restaurant to serve clients and do not follow the menu, or if a client wants something different than what is being given the staff will try to comply. S4 stated during interview that he does most of the cooking and C1 will complain at every meal. S4 also stated if C1 doesn’t like the food he calls his family. LPA observed C1 complain about the lunch being served. C1 did eat some of the lunch but requested something different. During interview with C1 he stated he wants hot pockets, and Pringle's.

Allegation: Staff are not reporting incidents involving resident as required.

During interview with W1 and W3 the staff does not report incidents involving C1. W1 stated C1 fell twice, and the facility did not notify family. W3 states C1 has had

Continued on LIC9099C.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 15-AS-20240307100309
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: G & O RESIDENTIAL INC.
FACILITY NUMBER: 079201221
VISIT DATE: 01/03/2025
NARRATIVE
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Continued from LIC9099C.

a lot of incidents. The family observes injuries to C1 that the staff did not report. S1 stated C1 does have bumps and bruises, but staff did not feel it was something that needed to be reported. S7 stated when C1 is showered staff have observed some bruising and reported it to C1's responsible party.

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

Exit interview conducted and a copy of report was given.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7