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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803852
Report Date: 07/20/2023
Date Signed: 07/20/2023 11:53:35 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
07/14/2023 and conducted by Evaluator Farhaan Sarangi
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20230714121526
FACILITY NAME:THRIVE ADULT RESIDENTIAL CARE II, INC.FACILITY NUMBER:
486803852
ADMINISTRATOR:MARIA GOLITZENFACILITY TYPE:
735
ADDRESS:2340 CABOT CTTELEPHONE:
(510) 689-4911
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:4CENSUS: 4DATE:
07/20/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Caregiver, Glenn MaiapitTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff inappropriately handled a resident in care
Staff spoke inappropriately to a resident in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Thrive Adult Residential Care II, Inc. for the purpose of conducting a complaint investigation inspection and delivering findings. LPA was greeted at the door by Caregiver, Glenn Maiapit and was granted access into the facility.

During the course of the investigation, LPA interviewed staff, clients and various outside parties. LPA reviewed Client #1 and Client #2 files during the course of the investigation. LPA conducted a tour of the one story facility on July 20, 2023 and made observations.

Complaint alleges that staff inappropriately handled a resident in care. Based on interviews that were conducted, LPA could not prove or disprove that the alleged staff member inappropriately handled a resident in care. Furthermore, during interviewing, LPA learned of no concerns regarding the care of clients. During a tour of the facility, LPA and Caregiver observed the facility to be clean and at a comfortable temperature with all exits free from obstruction. (Report continued on LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
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
Control Number 21-AS-20230714121526
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: THRIVE ADULT RESIDENTIAL CARE II, INC.
FACILITY NUMBER: 486803852
VISIT DATE: 07/20/2023
NARRATIVE
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Complaint alleges that staff spoke inappropriately to a resident in care. Based on interviews that were conducted, LPA could not prove or disprove that the staff member spoke inappropriately to clients. Furthermore, during interviewing, LPA learned of no concerns regarding the care of clients. During the client file reviews, LPA learned that the facility appropriately reappraised both clients recently. LPA also observed recent addendums to the Individual Program Plan (IPP) for both clients in care which was filled out, signed and dated.

A finding that the complaint allegations of Staff inappropriately handled a resident in care and Staff spoke inappropriately to a resident in care are unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted and a copy of this was report was signed and given to the Caregiver.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2