Complaint Investigation Report

Good Samaritan Residential Care Facility, Hayward09/20/2023Licence 019200020

Census6
Date signed09/20/2023 12:43:57 PM
The inspector’s account

019200020-9-20-2023-15-AS-BFOG-CZU5ZE-20240125192350

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1515 CLAY STREET, STE. 310

This is an official report of an unannounced visit/investigation of a complaint received in our office on

09/12/2023 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20230912113008

Licensing Program Analyst (LPA) Kelly Nguyen arrived unannounced to conduct investigation on the above allegation. LPA met with staff Ellen Jovero; LPA explained the purpose of the visit. Administrator Franklin Bautista later arrived.

At 9:55 am, LPA interviewed Client 1 (C1). C1 was able to respond to LPA with a nod and a couple of words. Based on an interview with C1, C1 states that he doesn’t like the facility, but none of the staff here hurts anyone here. At 10:15am LPA interviewed Client 2 (C2). C2 stated that staff here tried to prevent me from AWOL, but none of the staff here hit me. At 11:00am LPA interview Client 3 (C3). C3 stated that “I don’t see any staff here hit any of my house mates”. LPA interviewed S1, S2, S3, S4, and S5 all stated that C2 is the one that attacks all the staff due to C2 behaviors. All 5 staff stated that they have never hit any clients here at the facility.

Based on interviews and records review, the above allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Exit interview conducted and a copy of this report is provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction