011441162-2-2-2023-15-AS-YFLS-CNPRBJ-20230203115249

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 011441162
Report Date: 02/02/2023
Date Signed: 02/02/2023 01:47:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/23/2021 and conducted by Evaluator Lizette Francisco

COMPLAINT CONTROL NUMBER: 15-AS-20210323133448

FACILITY NAME:	GALICIA'S TULIP CARE HOME #2		FACILITY NUMBER:	011441162
ADMINISTRATOR:	GALICIA, CONSUELO		FACILITY TYPE:	740
ADDRESS:	745 CINNAMON COURT		TELEPHONE:	(510) 783-4888
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY:	6	CENSUS: 3	DATE:	02/02/2023
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Consuelo Galicia, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident is being financially abused.

INVESTIGATION FINDINGS:

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On 2/2/2023 Licensing Program Analyst(s) (LPAs) L. Francisco and P. Watson arrived unannounced to deliever findings for the allegation above. Upon arrival LPAs were greeted by caregiver Perlita Peria. Administrator, Consuelo Galicia arrived at 1:30 PM.

On 3/23/2021, Licensing Program Analyst (LPA) Luisa Fontanilla initiated 10-day investigation via telephone due to the shelter in place order and spoke with Administrator Connie Galicia. LPA explained purpose of the call.
LPA obtained Resident 1 (R1) records and interviewed staff on 3/23/2021. On 4/9/2021, LPA met with Ombudsman Charmaine Brent, APS Marietta Arroyo, Hayward Police Detective Sangha and LPA Alicia DelMundo via zoom to discuss concerns regarding R1’s financial issues.

Report continues on 9099 C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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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Control Number 15-AS-20210323133448

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: GALICIA'S TULIP CARE HOME #2	FACILITY NUMBER: 011441162
	VISIT DATE: 02/02/2023

NARRATIVE

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LPA interviewed Staff 1 (S1) on 3/23/2021. S1 denied R1 being financially abused at the facility. S1 states R1 does not allow anyone to enter R1’s room. S1 added that the facility uses the Administrator’s credit card in ordering R1’s medications. S1 denied knowing about R1’s finances.
On 3/26/2021, LPA interviewed Administrator who denied the allegation that the resident is being financially abused. Administrator states R1 is alert and writes own check. Administrator said she uses her credit card when ordering R1’s medications and other miscellaneous needs, presents the receipt to R1 and R1 writes the check to reimburse her. Administrator denied any knowledge about R1’s credit card. Administrator also said that R1 is very private and did not share any financial information with her or any of the staff.
During the course of investigation, LPA obtained R1’s bank records. LPA was informed that the bank was conducting their own investigation on potential fraudulent charges on R1’s accounts.
On 1/26/2023, LPA followed up the case with Hayward Police Department Det. Sangha. LPA was informed that no criminal charges were filed and that the case is closed.

Based on interviews conducted and records reviewed, 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 will be provided to the Administrator.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC9099 (FAS) - (06/04)

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