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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601459
Report Date: 01/29/2026
Date Signed: 01/29/2026 02:18:25 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
10/23/2025 and conducted by Evaluator Laura Hall
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20251023134127
FACILITY NAME:BALTIC SEA MANORFACILITY NUMBER:
075601459
ADMINISTRATOR:PRICE, VIVIANFACILITY TYPE:
740
ADDRESS:311 BALTIC SEA COURTTELEPHONE:
(925) 783-0988
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:6CENSUS: 6DATE:
01/29/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Gloria Martinez de Godsen, CaregiverTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not prevent resident from being sexually assaulted

Adult in home is touching resident inappropriately
INVESTIGATION FINDINGS:
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On 1/29/2026 at 2:00pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver a complaint finding for the allegations above. LPA met with Gloria Martinez de Godsen, Caregiver and explained the reason for the visit.

During the course of the investigation the Department conducted interviews with staff, resident, collected and reviewed records.

Allegation: Staff did not prevent resident from being sexually assaulted

During the initial interview, W1 reported that R1 stated she was sexually active with someone at the facility but did not identify the individual. S1 stated

Continued on LIC9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
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 3
Control Number 15-AS-20251023134127
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: BALTIC SEA MANOR
FACILITY NUMBER: 075601459
VISIT DATE: 01/29/2026
NARRATIVE
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Continued from LIC9099.

that the Pittsburgh Police Department conducted a brief inquiry and determined no further investigation was necessary. The LPA reviewed emails from R1’s conservator dated 10/23/2025 indicating no concerns regarding abuse or R1’s safety and dated 10/24/2025 noting that R1’s primary care physician would attempt to flag her chart for provider awareness. Staff interviews (S1, S2, S3, S5, and R2) confirmed there is only one male staff member who regularly works at the facility, and male staff do not assist female residents with bathing, grooming, incontinence care, or enter female shared rooms; the male staff member may assist with meals or accompany residents outside. R1 was not interviewed due to diagnosis per appraisal needs and services plan dated 4-9-2025.

Allegation: Adult in home is touching resident inappropriately

During the initial interview, W1 reported and expressed concern that an adult in the home may be touching R1 inappropriately. W1 stated that R1 is unable to perform activities of daily living (ADLs’) including bathing and grooming independently; however, R1 stated she gets shaved but when asked who performs the shaving, she was unable to provide an answer. S1 stated that shaving is completed for hygiene purposes and to help reduce the risk of urinary tract infections. S2 stated that she performs the shaving to facilitate proper hygiene and reported that she assists R1 most of the time. S2 further stated that if she is unavailable, another female staff member aids female

Continued on LIC9099C.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20251023134127
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: BALTIC SEA MANOR
FACILITY NUMBER: 075601459
VISIT DATE: 01/29/2026
NARRATIVE
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Continued from LIC9099C.

residents. LPA reviewed email from W2 dated 10/24/2025, which stated R1 can make false statements when provided leading questions due to her diagnosis.

Based upon the information obtained and the interviews conducted during the investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conducted and a copy of report was given.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3