015600585-1-14-2024-15-AS-YFLS-D3JUZ9-20240320160111

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015600585
Report Date: 01/12/2024
Date Signed: 01/14/2024 04:09:35 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
01/12/2024 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20240112141141

FACILITY NAME:	VILLA MONTGOMERY		FACILITY NUMBER:	015600585
ADMINISTRATOR:	ADORA ROSE M SANTIAGO		FACILITY TYPE:	735
ADDRESS:	22240 MONTGOMERY STREET		TELEPHONE:	(510) 886-1813
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	20	CENSUS: 11	DATE:	01/12/2024
		UNANNOUNCED	TIME BEGAN:	04:20 PM
MET WITH:	Ruby Bucu, Care Staff		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff are not ensuring the comfort of residents in care

INVESTIGATION FINDINGS:

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On 1/12/24 at 4:20 p.m, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegation above. LPA met with Ruby Bucu, Care Staff and explained the purpose of the visit.

LPA spoke with S1 via the telephone. S1 stated that the heater has been inoperable since the on-set of the cooler weather. S1 further stated that the owner did have 1 repair company look at the heater and determined it needs to be replaced. LPA toured the facility and observed space heaters in all of the bedrooms occupied by residents. All residents interviewed said that they were comfortable.

This agency has investigated the above allegation. We have found that the complaint was 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, a copy of this report provided via email.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

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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