342700907-12-5-2023-27-AS-SRIN-CYX2C8-20231227161619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700907
Report Date: 12/05/2023
Date Signed: 12/05/2023 02:51:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/13/2023 and conducted by Evaluator Christina Valerio

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20231113232459

FACILITY NAME:	HOPEFUL TOMORROW HOMES, LLC		FACILITY NUMBER:	342700907
ADMINISTRATOR:	ANDRADA, MONALYN		FACILITY TYPE:	737
ADDRESS:	12857 CHEROKEE LANE		TELEPHONE:	(916) 890-4282
CITY:	GALT	STATE: CA	ZIP CODE:	95632
CAPACITY:	4	CENSUS: 3	DATE:	12/05/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Jasmin Samson		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff caused an injury to a client while in care

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to complete a complaint investigation and to deliver investigation report findings. Administrator Monalyn was out of the community with a resident and appointed facility lead staff Jasmin Samson to carry out the visit.

LPA reviewed facility documentation. An incident occurred with Resident 1 (R1) on 11/10/2023 at 7:30 AM. R1 became upset, left the house, and walked to the road while staff followed. R1 kicked a car parked outside the facility gate, hit a parked care inside the gate 4x times, and attempted to hit another car. R1 attempted to hit another car, and the staff, which was standing on R1's right side, attempted to block R1 from hitting the staff and car using a pad. Accord to the report, the pad accidentally hit R1's face (right side, between cheek and lower eyelid) with the edge of the pad, causing light discoloration. R1 then hit the staff's left arm, but no injury was noted. According to the report, R1 made up statements after calling 911 and stated that Staff 1 (S1) hit R1 and R1did not hit the cars.
Continues on LIC 9099 - C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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 27-AS-20231113232459

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HOPEFUL TOMORROW HOMES, LLC	FACILITY NUMBER: 342700907
	VISIT DATE: 12/05/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

...Continued from LIC 9099

On 11/16/23, LPA interviewed Resident 1 (R1). R1 did not want to speak about what happened to R1's eye. R1 stated if LPA wanted to discuss R1's eye, the information that was told to LPA is not true.

LPA interviewed an outside agency. Based on the interview, the facility sent notification of the incident via a Shared Information Report. LPA observed R1's face on 11/16/23. LPA observed discolored skin located under R1's eye, which matched the description on a Shared Information Report.

Based on interviews with staff, all staff interviews denied any staff hitting any residents in care.

LPA observed the facility on 12/05/23. Facility staff showed LPA the different pads that staff utilize to ensure residents or staff do not get hurt in the event the resident is expressing harmful behaviors. LPA obtained pictures for reference.

Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, no deficiencies cited. Exit interview was held and a copy of report was left at the facility.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2