015600341-2-11-2021-15-AS-KHOS-BYJRWS-20210224122337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015600341
Report Date: 02/11/2021
Date Signed: 02/11/2021 11:48:29 AM

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
02/10/2021 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20210210161339

FACILITY NAME:	CARLTON PLAZA OF SAN LEANDRO		FACILITY NUMBER:	015600341
ADMINISTRATOR:	NANCY RANDHAWA		FACILITY TYPE:	740
ADDRESS:	1000 EAST 14TH ST.		TELEPHONE:	(510) 636-0660
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94577
CAPACITY:	199	CENSUS: 126	DATE:	02/11/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Nancy Randhawa, Administrator		TIME COMPLETED:	09:58 AM

ALLEGATION(S):

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Facility courtyard is in disrepair

INVESTIGATION FINDINGS:

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On 02/11/21 at 9:15AM, Licensing Program Analyst (LPA) Daisy Panlilio conducted a tele-visit with administrator to investigate the above allegation. LPA explained the purpose of the tele-visit with administrator. Due to COVID-19 shelter in place order, administrator was not physically available to sign this report. LPA, along with administrator, toured the facility's outside courtyard from the memory care unit. LPA observed well maintained patio furnitures, shade umbrellas, a gazebo, planter boxes for residents to plant, benches, chairs and walkways. Pathways were observed unobstructed. Concrete pathways were observed level to the ground. No tripping hazards were observed near or at the 2 side gates leading outside the courtyard. LPA observed the outside courtyard to be well maintained and in good repair.

This department had investigated the complaint alleging that facility courtyard is in disrepair. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint. No deficiencies cited.

Exit Interview conducted and a copy of this report provided to administrator via email.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Rajind Basi	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021

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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