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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385600399
Report Date: 09/09/2021
Date Signed: 09/09/2021 02:16:38 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/31/2021 and conducted by Evaluator Murial Han
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20210831111654
FACILITY NAME:SAN FRANCISCO RCFEFACILITY NUMBER:
385600399
ADMINISTRATOR:ADELA MORALESFACILITY TYPE:
740
ADDRESS:887 POTRERO AVENUETELEPHONE:
(628) 206-6436
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:59CENSUS: 39DATE:
09/09/2021
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Adminstrator, Adela MoralesTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff touched resident in a sexual manner.
Staff verbally abused resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/9/2021, Licensing Program Analyst (LPA) Murial Han and LPA Komal Charitra conducted an unannounced 10-day initial complaint inspection regarding the above allegations. LPA Han and LPA Charitra met with the Administrator, Adela Morales and explained the purpose of the visit.

Regarding to the allegations of staff touched resident in a sexual manner and staff verbally abused resident, these were reported to the Department in the past in reference to Complaint # 14-AS-20210310114055. At that time, the Department has addressed and completed the investigation and determined the allegations to be unfounded. Therefore, after review, this allegation is also unfounded.

We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis.

This report is reviewed and discussed with the Administrator. A copy is provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Julio Montes
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
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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