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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015601324
Report Date: 05/06/2022
Date Signed: 05/06/2022 02:09:52 PM

Unfounded


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
05/06/2022 and conducted by Evaluator Gregory Clark
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20220506104139
FACILITY NAME:SUNRISE CARE HOMEFACILITY NUMBER:
015601324
ADMINISTRATOR:TAYAG, NANCYFACILITY TYPE:
740
ADDRESS:1447 VIA LUCASTELEPHONE:
(510) 481-1300
CITY:SAN LORENZOSTATE: CAZIP CODE:
94580
CAPACITY:6CENSUS: DATE:
05/06/2022
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Nancy Tayag, AdinistratorTIME COMPLETED:
01:56 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Illegal Eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/6/22 at 1:35 p.m. Licensing Porgram Analyst (LPA) Greg Clark arrived at the facilty to investigate the above allegation. LPA was told by care staff that R1 does not live at this facility.

This agency has investigated the complaint alleging illegal eviction We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory ClarkTELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
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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