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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201363
Report Date: 07/15/2025
Date Signed: 07/15/2025 05:39:38 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
05/22/2025 and conducted by Evaluator Laura Hall
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250522122029
FACILITY NAME:ADAURE HOME CAREFACILITY NUMBER:
079201363
ADMINISTRATOR:ESOMONU, JUSTINEFACILITY TYPE:
735
ADDRESS:1073 METTEN AVETELEPHONE:
(925) 214-8468
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:6CENSUS: 4DATE:
07/15/2025
UNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Christian Smith, Direct Care SupportTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff are not properly supervising client resulting in elopement
INVESTIGATION FINDINGS:
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On 7/15/2025, at 4:25pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver a complaint finding for the allegation above. LPA met with Christian Smith, Direct Care Support. Administrator, Justine Esomonu arrived at 4:35pm, and explained the reason for the visit.

During the course of the investigation the Department conducted interviews with staff, witness, obtained and review records.

Allegation: Staff are not properly supervising client resulting in elopement.

Based on interview with W1, C1 often refuses transportation to school, will not board the van, and the facility staff has no idea. W1 stated C1 is not

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

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
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 5
Control Number 15-AS-20250522122029
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: ADAURE HOME CARE
FACILITY NUMBER: 079201363
VISIT DATE: 07/15/2025
NARRATIVE
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Continued from LIC9099.

properly being supervised by staff resulting in elopement. W1 stated on May 17th, 2025, C1 went to Dublin on the BART unassisted. The BART police called W1’s coworker and they contacted the facility. W1 also stated the driver of the van reported on May 21, 2025, that C1 did not board the van, C1 walked out of the facility and said he was going to open a checking account at Wells Fargo. S1 stated during interview that C1 ran out the house and went to the BART station. S1 stated he followed him but somehow C1 was able to get on the BART and go to Dublin. The BART police brought C1 back to the facility. During interview S2 stated C1 goes out to the van by himself and S2 is not aware that C1 doesn’t get into the van. LPA reviewed the addendum to the Individual Program Plan dated March 6, 2025, which indicated C1 has 2:1 behavioral support effective January 1, 2025, through June 30, 2025.

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: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
05/22/2025 and conducted by Evaluator Laura Hall
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250522122029

FACILITY NAME:ADAURE HOME CAREFACILITY NUMBER:
079201363
ADMINISTRATOR:ESOMONU, JUSTINEFACILITY TYPE:
735
ADDRESS:1073 METTEN AVETELEPHONE:
(925) 214-8468
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:6CENSUS: 4DATE:
07/15/2025
UNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Christian Smith, Direct Care SupportTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
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9
Staff are not properly dispensing clients medication
INVESTIGATION FINDINGS:
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On 7/15/2025, at 4:25pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver a complaint finding for the allegation above. LPA met with Christian Smith, Direct Care Support. Administrator, Justine Esomonu arrived at 4:35pm, and explained the reason for the visit.

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

Allegation: Staff are not properly dispensing client’s medication

Based on interview with W1 there is a possibility that staff are not properly

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

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20250522122029
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: ADAURE HOME CARE
FACILITY NUMBER: 079201363
VISIT DATE: 07/15/2025
NARRATIVE
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Continued from LIC9099.

dispensing C1’s. During interviews with S1 and S2 both state that C1 takes medication every day and without hesitation. LPA reviewed the medication administration record (MAR) which indicates with a signature that C1 have not missed any medication.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.

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

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20250522122029
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: ADAURE HOME CARE
FACILITY NUMBER: 079201363
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/16/2025
Section Cited
CCR
85078(a)
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85078 Responsibility for Providing Care and Supervision
(a) In addition to Section 80078, the following shall apply:
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Administrator agreed to hire additional staffing to support C1 or submit a list of which staff will be supporting C1 for 2:1 support.
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Based on interview the Licensee did not comply with the section cited above in supervising C1, which poses an immediate health and safety issue 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: 07/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5