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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486801728
Report Date: 11/14/2024
Date Signed: 11/18/2024 10:42:15 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/02/2024 and conducted by Evaluator Araceli Canela
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240702153511
FACILITY NAME:GLAJAN CARE, INC.FACILITY NUMBER:
486801728
ADMINISTRATOR:MILES, GLADYSFACILITY TYPE:
735
ADDRESS:163 DEVONSHIRE ST.TELEPHONE:
(707) 656-6012
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:6CENSUS: 3DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
12:38 PM
MET WITH:Keith CooperTIME COMPLETED:
01:54 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are misusing residents funds.
Staff are storing expired medication for a resident in care.
Staff are administering medication that is not prescribed to a resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Araceli Canela arrived unannounced for the purpose of continuing complaint investigation. It was alleged staff are misusing residents funds, but reporting party could not provide how, just that clients C1 & C2 did not get a haircut. LPA reviewed P&I funds and took statements & no one corroborated that clients funds are missing or being missused by staff. It was also alleged, staff are storing expired medication & staff are administering medication that is not prescribed to a resident in care. More specifically, that client C1 had expired medication and C2 was provided melatonin at night. LPA reviewed medication & both client bedrooms, took statements & LPA did not observe exprired medication or melatonin in medication box. Facility also denies allegations. Although the allegation may be true, based on the observations, records & statements, there is not a preponderance of evidence to prove or, disprove, the above allegations. Therefore, all of the above allegations are UNSUBSTANTIATED.
Report l emailed.
No citations issued during this visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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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