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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547203298
Report Date: 08/31/2021
Date Signed: 08/31/2021 02:47:22 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/02/2021 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20210802161309
FACILITY NAME:AUTUMN OAKSFACILITY NUMBER:
547203298
ADMINISTRATOR:ONG, ANTONIO G.FACILITY TYPE:
740
ADDRESS:848 N. JAYE STREETTELEPHONE:
(559) 784-4144
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:44CENSUS: 27DATE:
08/31/2021
UNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Antonio OngTIME COMPLETED:
01:51 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sexually abused another resident while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) M. Medina conducted a subsequent facility visit to deliver findings. LPA identified herself and discussed the purpose of visit and the findings with Administrator, Tony Ong.

This Department conducted interviews and reviewed the police report during complaint investigation. During review of information received, this Department found that the facility contacted all pertinent agencies, and moved R1's room to another section of facility to allow for increased supervision. Porterville Police Department conducted and investigation, the case was documented and no charges would be filed based on information obtained.

This agency has investigated the complaint allegation and have found that the complaint was unfounded, therefore we have dismissed the complaint.

No deficiencies cited. Exit interview conducted
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021
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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