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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202592
Report Date: 10/26/2021
Date Signed: 11/01/2021 09:26:13 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/17/2021 and conducted by Evaluator Anna Bui
COMPLAINT CONTROL NUMBER: 26-AS-20210617095248
FACILITY NAME:FOOTHILL ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
435202592
ADMINISTRATOR:ROQUE JAMES UGALEFACILITY TYPE:
735
ADDRESS:13655 FOOTHILL AVETELEPHONE:
(669) 231-3861
CITY:SAN MARTINSTATE: CAZIP CODE:
95046
CAPACITY:4CENSUS: 3DATE:
10/26/2021
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Angelica AtrianoTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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1. Staff smokes marijuana with clients at facility.
2. Staff engaged in inappropriate relationships with clients.
3. Staff did not treat clients with dignity.
INVESTIGATION FINDINGS:
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On 10/26/2021 at 12:00 pm, Licensing Program Analyst (LPA) Anna Bui conducted an unannounced complaint investigation visit to deliver the findings to the above allegations. LPA met with Administrator Angelica Atriano.

On 06/24/2021, an initial 10-day complaint investigation visit was completed.

Between 06/24/2021 and 10/21/2021, 7 staff were interviewed. 7 out of 7 staff stated they have not seen or heard of any staff engaging in inappropriate relationships with residents. 7 out of 7 staff stated they have not seen or heard of any staff treating residents unfairly or mistreating the residents. 7 out of 7 staff stated they have not seen any staff smoking marijuana with residents at the facility. 1 staff stated staff have smoked cigarettes at the facility but not marijuana. 1 staff stated marijuana usage is not allowed before or on the shift, and staff are aware that they are not allowed to come to work smelling like marijuana.
-Continued, see LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Anna Bui
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
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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Control Number 26-AS-20210617095248
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: FOOTHILL ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 435202592
VISIT DATE: 10/26/2021
NARRATIVE
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On 06/24/2021 and 10/18/2021, 2 residents were interviewed. 1 out of 2 residents stated there are no residents that smoke marijuana at the facility. 1 out of 2 residents stated that he or she smokes marijuana; however, he or she smokes alone and has never smoked marijuana with staff. 2 out of 2 residents stated they have not seen staff having inappropriate relationships with residents, and staff have not been inappropriate with them. 2 out of 2 residents stated staff are nice to them and have not treated them unfairly.

A review of facility’s policy showed that the facility does not allow marijuana usage on the shift, and if a staff uses marijuana on the shift or smells like marijuana, they will be asked to leave the facility.

The Department has investigated the above allegations. Based on interviews and records reviewed, the Department found the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation did or did not occur.

No deficiencies were cited during today’s visit.

Exit interview was conducted with Administrator Angelica Atriano. This report was reviewed with Administrator Angelica Atriano, and a copy was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Anna Bui
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC9099 (FAS) - (06/04)
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