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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397000014
Report Date: 06/24/2022
Date Signed: 06/27/2022 03:18:59 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/21/2022 and conducted by Evaluator Bruce Jacobs
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220621125416
FACILITY NAME:BRISBANE'S GUEST HOMEFACILITY NUMBER:
397000014
ADMINISTRATOR:GAPASIN, SEAN C.FACILITY TYPE:
735
ADDRESS:9512 BRISBANE PLACETELEPHONE:
(209) 952-9818
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:6CENSUS: 5DATE:
06/24/2022
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Daniel RuizTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Client is not afforded privacy while in care
INVESTIGATION FINDINGS:
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LPA Bruce Jacobs conducted a complaint investigation and met with care staff Daniel Ruiz and spoke to Facility Administrator Esther Gapasin by phone and explained the purpose of this visit. A complaint investigation was conducted on the allegations listed above. LPA inspected the home on June 22, 2022 and interviewed staff and the Facility Administrator. Other witnesses were contacted on later dates.

The investigation concluded the the facility staff walked in on a client (C-1) who was in the bathroom and using the toilet. The staff did not knock on the door or announce that they were entering the bathroom.

Therefore, based on LPA’s observations and interviews conducted, the above allegation is substantiated and are being cited on the following 9099Ds.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
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-20220621125416
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: BRISBANE'S GUEST HOME
FACILITY NUMBER: 397000014
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2022
Section Cited
CCR
80072(a)(1)
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Personal Rights:(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons.
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Plan of correction: Facility will provide in-service training for care staff on the resident's personal rights and send CCL proof of training within 30 days.
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This requirement was not met as evidenced by: Facility staff walked in on a client who was using the bathroom without knocking or otherwise announced that they were entering. This poses a potential health and safety risk to clients in care.
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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: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/21/2022 and conducted by Evaluator Bruce Jacobs
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220621125416

FACILITY NAME:BRISBANE'S GUEST HOMEFACILITY NUMBER:
397000014
ADMINISTRATOR:GAPASIN, SEAN C.FACILITY TYPE:
735
ADDRESS:9512 BRISBANE PLACETELEPHONE:
(209) 952-9818
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:6CENSUS: 5DATE:
06/24/2022
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Daniel RuizTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Facility gate is locked with a rope.
INVESTIGATION FINDINGS:
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LPA Bruce Jacobs conducted an unannounced complaint visit at the facility and met with care staff Daniel Ruiz and spoke with Facility administrator Esther Gapasin by phone to discuss and complete this complaint investigation. LPA provided findings regarding the allegation listed above. The investigation was conducted by LPA Jacobs and consisted of facility inspections and interviews with facility management and staff. The residents and other witnesses were contacted and interviewed.

The complaint allegation listed above was investigated and the investigation concluded that the allegation was unsubstantiated. There was a string loosely wrapped around the latch on the side yard gate. However, the string was not tied and did not prevent the gate from opening in the event of an emergency exit. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that a violation occurred

Based on LPA’s observations and interviews conducted, the preponderance of evidence standard has not been met, therefore the above allegation is determined to be UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3