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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700661
Report Date: 10/16/2025
Date Signed: 10/21/2025 11:58:36 AM

Substantiated


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
09/03/2025 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250903141740
FACILITY NAME:CASA DE ESPERANZAFACILITY NUMBER:
392700661
ADMINISTRATOR:BROWN, PAMELA & MAGANA, LUFACILITY TYPE:
735
ADDRESS:400 OLIVINE AVENUETELEPHONE:
(510) 385-8463
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY:4CENSUS: 2DATE:
10/16/2025
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Giselle ContrerasTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff is not responding to authorized representative timely.
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 10/16/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff person, Giselle Contreras, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator, Luis Magana, to inform him that CCL was present at this time.
The facility designated Administrator arrived later to this facility while this LPA was conducting this visit.
Current census was (2) residents, of which (1) resident, was out of the facility at this time.
The purpose of this visit was to deliver the findings from this investigation to this facility, and it's representative, at this time.
Based on interviews conducted during the course of this investigation, it was learned that several attempts were made from an aurhorized representative for the current facility residents in order to finalize several documents with the facility Licensee.
These documents were essential in continuing the level of care and supervision to the residents in care and maintaining compliance with all applicable rules and regulations.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
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 3
Control Number 27-AS-20250903141740
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: CASA DE ESPERANZA
FACILITY NUMBER: 392700661
VISIT DATE: 10/16/2025
NARRATIVE
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It was learned that these forms and documents required the acknowledgement and signature of the facility Licensee in order to finalize and move forward.
It was learned that several attempts were made from the authorized representative out to the facility Licensee who did not return any of these attempts or properly sign and return the forms and documents.
It was learned that the authorized representative even reached out to the facility designated Administrator, Luis Magana, to relay this information and request that he go ahead and get in contact with the facility Licensee, Pamela Brown, so that she could go ahead and complete the forms and documents and get them back to the authorized representative.
Based on a review of the facility designated Administrator, Luis Magana's, email history on his cell phone, it was observed that the CAP documents were sent to him by Pamela Brown but were not forwarded over to the authorized representative since the date of 09/29/2025.

As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

Appeal rights were printed and a copy was left with the facility designated Administrator at this time.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20250903141740
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: CASA DE ESPERANZA
FACILITY NUMBER: 392700661
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/23/2025
Section Cited
CCR
85072(b)(3)
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Personal Rights
The licensee shall insure that each client is accorded the following personal rights.
To have communications to the facility from his/her relatives or authorized representative answered promptly and completely.
This facility was found to be deficient as
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The facility designated Administrator stated that he will reach out to the contact person provided to him from Valley Mountain Regional Center (VMRC) and submit all requested forms and documents that were previously required. A statement of correction will be completed and submitted
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evidenced by not responding to communications from authorized representatives for the clients in a timely manner. This posed a possible threat to the Health, Safety, and Personal Rights of the residents.
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into CCL for review by this LPA once the contact had been made with VMRC with submission of all requested forms and documents by this facility.
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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: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3