011400627-4-21-2023-15-AS-KHOS-CRFKWD-20230502081546

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 011400627
Report Date: 04/18/2023
Date Signed: 04/21/2023 09:05:21 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, 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
04/07/2023 and conducted by Evaluator Jennifer Walden

COMPLAINT CONTROL NUMBER: 15-AS-20230407090005

FACILITY NAME:	ST. PAUL'S TOWERS		FACILITY NUMBER:	011400627
ADMINISTRATOR:	YUEN, CONNIE		FACILITY TYPE:	741
ADDRESS:	100 BAY PLACE		TELEPHONE:	(510) 835-4700
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94610
CAPACITY:	320	CENSUS:	DATE:	04/18/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Connie Yuen		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not issue a refund

INVESTIGATION FINDINGS:

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AGPA, Walden confirmed that the original refund check was issued within 14 days of re-occupancy of the unit through provider’s bank; however, it was never received by complainant. Provider reissued the check and sent it overnight. AGPA confirmed with complainant that the check has been received and would like the complaint closed. No violation were identified.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Allison Nakatomi	TELEPHONE: (916) 531-5336
LICENSING EVALUATOR NAME: Jennifer Walden	TELEPHONE: (916) 651-8148
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

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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