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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201332
Report Date: 01/29/2026
Date Signed: 01/29/2026 10:56:21 AM

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
01/09/2026 and conducted by Evaluator Laura Hall
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20260109144956
FACILITY NAME:GCJ ARFFACILITY NUMBER:
079201332
ADMINISTRATOR:NUNES, JOSE L. JRFACILITY TYPE:
735
ADDRESS:1860 E 18TH STTELEPHONE:
(925) 503-7162
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:4CENSUS: 4DATE:
01/29/2026
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Cristina Vazquez, AdministratorTIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Staff exposed resident to contaminants.
INVESTIGATION FINDINGS:
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On 1/29/2026 at 10:35am, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver a complaint findings for the allegation above. LPA met with Cristina Vazquez, Administrator and explained the reason for the visit.

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

Allegation: Staff exposed resident to contaminants.

During the initial interview W1 reported a staff member contaminated C1’s vape. C1 stated during interview a new vape was purchased and everything

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

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
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-20260109144956
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: GCJ ARF
FACILITY NUMBER: 079201332
VISIT DATE: 01/29/2026
NARRATIVE
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Continued from LIC9099.

is fine now. S1 and S2 stated during interview that no one goes into C1’s room and when C1 leaves she locks the bedroom door. Client interviews (C2 and C3) confirmed staff give privacy. Staff will knock before entering the room and if they do not want staff to go into their room staff will abide.

Based upon the interviews conducted during the investigation. The above allegation is 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 report was given.

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

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2