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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803228
Report Date: 03/16/2022
Date Signed: 03/16/2022 12:53:32 PM



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
03/03/2022 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20220303144957
FACILITY NAME:CRESTWOOD HOPE CENTERFACILITY NUMBER:
486803228
ADMINISTRATOR:DONNABELL GALACIAFACILITY TYPE:
740
ADDRESS:115 ODDSTAD DRIVETELEPHONE:
(707) 552-0215
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY:24CENSUS: 20DATE:
03/16/2022
UNANNOUNCEDTIME BEGAN:
11:48 AM
MET WITH:Donnabell Galacia, Administrator TIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents are being sexually abused by an unknown perpetrator
Staff physically injured residents
Resident was hospitalized for an unknown reason
Staff are overmedicating resident
Staff did not seek medical attention for resident
Resident is being threatened
Resident sustained unexplained injuries
Staff did not notify resident's authorized representative of incidents
Resident is not provided with appropriate footwear
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/16/2022 LPA Tobola conducted a facility visit for the purpose of delivering complaint findings. LPA arrived and was greeted by Administrator, Donnabell Galacia (DG). LPA conducted interviews with staff and reviewed facility documentation.

Based on interviews with Administrator and Staff (S1) and a review of client census reports LPA found that client (C1) does not currently reside in the RCFE licensed facility. In addition, upon client census review C1 had not resided in the RCFE licensed facility between January 2021 to February 2021, therefore the allegations did not occur in the CCLD licensed RCFE facility and are determined to be UNFOUNDED.

This agency has investigated all of the complaint allegations listed above. We have found that the complaint allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

No deficiencies cited during the visit. LPA provided Administrator with an email copy of the complaint report.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic TobolaTELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022
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 2
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
03/03/2022 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20220303144957

FACILITY NAME:CRESTWOOD HOPE CENTERFACILITY NUMBER:
486803228
ADMINISTRATOR:DONNABELL GALACIAFACILITY TYPE:
740
ADDRESS:115 ODDSTAD DRIVETELEPHONE:
(707) 552-0215
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY:24CENSUS: 20DATE:
03/16/2022
UNANNOUNCEDTIME BEGAN:
11:48 AM
MET WITH:Donnabell Galacia, Administrator TIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident's dental care needs are not being met
Resident was injured by another resident
Staff did not report abuse of resident to appropriate agencies
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/16/2022 LPA Tobola conducted a facility visit for the purpose of delivering complaint findings. LPA arrived and was greeted by Administrator, Donnabell Galacia (DG). LPA conducted interviews with staff and reviewed facility documentation.

Based on interviews with Administrator and Staff (S1) and a review of client census reports LPA found that client (C1) does not currently reside in the RCFE licensed facility. In addition, upon client census review C1 had not resided in the RCFE licensed facility between January 2021 to February 2021, therefore the allegations did not occur in the CCLD licensed RCFE facility and are determined to be UNFOUNDED.

This agency has investigated all of the complaint allegations listed above. We have found that the complaint allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

No deficiencies cited during the visit. LPA provided Administrator with an email copy of the complaint report.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic TobolaTELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022
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 2