015601307-8-17-2023-15-AS-KHOS-CUWQ4V-20230821115057

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015601307
Report Date: 08/17/2023
Date Signed: 08/17/2023 12:38:53 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
02/28/2022 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20220228135747

FACILITY NAME:	RUUS HOME-RCFE		FACILITY NUMBER:	015601307
ADMINISTRATOR:	JUGARAP, SIMPORIANA P.		FACILITY TYPE:	740
ADDRESS:	28269 RUUS ROAD		TELEPHONE:	(510) 432-4684
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY:	6	CENSUS: 4	DATE:	08/17/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Simporiana Jugarap, Administrator		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Facility failed to arrange or assist client with medical needs
Facility is not allowing client to have communications with family

INVESTIGATION FINDINGS:

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On 08/17/23 at 11:30AM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator (ADM) to deliver the findings of above allegations. LPA explained the purpose of the visit with ADM.

Allegation: Facility failed to arrange or assist client with medical needs
Investigation Finding: Unsubstantiated
During investigation, LPA interviewed resident (R1) who confirmed that staff (ADM, S1) assisted and accompanied him to his medical and dental appointments. LPA also interviewed staff (ADM, S1) who confirmed they scheduled and accompanied R1 to all his medical and dental appointments. Based on interviews and record reviews which were conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that facility failed to arrange or assist client with medical needs is unsubstantiated. Continued on next page, LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20220228135747

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: RUUS HOME-RCFE	FACILITY NUMBER: 015601307
	VISIT DATE: 08/17/2023

NARRATIVE

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Allegation: Facility is not allowing client to have communications with family
Investigation Finding: Unsubstantiated
During investigation, resident (R1) and staff (ADM, S1) confirmed with LPA that R1 maintained frequent communication with his family (sisters) using his personal cell phone. ADM stated R1 frequently talked to his sisters using his cell phone and would refuse to contact or talk with other members of his family. Based on interviews and record reviews which were conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that facility is not allowing client to have communications with family is unsubstantiated.

No deficiencies cited during visit.

Exit Interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC9099 (FAS) - (06/04)

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