216800912-3-7-2023-21-AS-BMOS-CPXSQW-20230315140523

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216800912
Report Date: 03/07/2023
Date Signed: 03/07/2023 09:36:45 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/26/2023 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20230126114745

FACILITY NAME:	BEACONLIGHT CARE HOME		FACILITY NUMBER:	216800912
ADMINISTRATOR:	HYPPOLITE, WALLY		FACILITY TYPE:	735
ADDRESS:	1468 SOUTH NOVATO BLVD		TELEPHONE:	(415) 756-5525
CITY:	NOVATO	STATE: CA	ZIP CODE:	94947
CAPACITY:	6	CENSUS: 5	DATE:	03/07/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Wally Hyppolite		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights - staff are not allowing client to attend ADP 5 days per week
Personnel Requirements - staff are not able to communicate with clients in care due to a language barrier
Criminal Record Clearance - adults living in the home are not fingerprint cleared and associated to the facility.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. This Department's investigation included a review of historical data for the facility and complaint subject; Thorough review of current pertinent records; interviews with staff, witnesses and others; as well as site visits to the facility. The following determinations are made: C1 and C1's caseworker state they are satisfied with the facility's handling of program attendance; While some staff are bilingual in order to communicate with non English speaking clients, no evidence of a language barrier was found; Site visit to facility, criminal record clearances for staff, and Administrator and witness statements suggest that no non fingerprint cleared adults are residing in the home. Although the allegations may be true, based on records reviewed and statements taken, there is not a preponderance of evidence to prove the allegations are or, are not, true. Therefore, the allegations are UNSUBSTANTIATED.

No citations issued today.
Report left.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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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