397001613-9-26-2024-27-AS-KHOS-D9NHMW-20241002061946

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397001613
Report Date: 09/26/2024
Date Signed: 09/26/2024 11:41:21 AM

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
05/30/2024 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20240530153153

FACILITY NAME:	GOLDEN ACRES HOME AND CARE II		FACILITY NUMBER:	397001613
ADMINISTRATOR:	MARIVIC TEANO-CHUA		FACILITY TYPE:	735
ADDRESS:	2002 E. HARDING WAY		TELEPHONE:	(209) 943-5420
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95205
CAPACITY:	15	CENSUS: 15	DATE:	09/26/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Floridiza Agtang		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff inappropriately touching resident
Staff making sexual comment to resident

INVESTIGATION FINDINGS:

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On 9/26/2024 at 10:15am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the complaint allegations noted above. LPA met with staff1 (S1) and explained the purpose of the visit. Administrator Marivic Teano-Chua was made aware of LPAs visit and purpose via phone and gave permission for S1 to sign in her absence. During this investigation, the Department conducted interviews with seven residents, four staff members, and one additional witness. The Department also reviewed facility file documentation including incident reports, physician report, and needs and service plan pertaining to resident1 (R1).

Allegation: Staff inappropriately touching resident. Department conducted interviews and record reviews as noted above. Based on interview, it was alleged that staff4 (S4) engaged in inappropriately touching R1’s private parts with S4’s hand over R1’s clothes which began six to twelve months prior to the allegations being made. {Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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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Control Number 27-AS-20240530153153

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: GOLDEN ACRES HOME AND CARE II	FACILITY NUMBER: 397001613
	VISIT DATE: 09/26/2024

NARRATIVE

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Additional interviews with staff and residents in care revealed no corroborated statements of witnessing staff inappropriately touching any residents in care. Departments review of file documentation did not reveal corroborating evidence of this alleged event taking place. Additionally, interview with S4 revealed a denial of this alleged event. As a result, there is not a preponderance of evidence to conclude staff inappropriately touched resident, therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

Allegation: Staff is making sexual comments to resident. Department conducted interviews and record reviews and noted above. Based on interview, it was alleged that S4 made sexually related inappropriate comments to R1 including references to private area body parts which began six to twelve months prior to the allegations being made. Additional interviews with staff and residents in care revealed no corroborated statements of witnessing staff making sexually related comments to any residents in care. Department review of file documentation did not reveal corroborating evidence of this alleged event taking place. Additionally, interview with S4 revealed a denial of this alleged event. As a result, there is not a preponderance of evidence to conclude staff made sexual comments to a resident, therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with S1 and a copy of this report was provided to S1. Appeal rights provided. LIC 811 provided.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

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