015601374-8-24-2023-15-AS-KHOS-CVSHPU-20230918062254

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015601374
Report Date: 07/19/2023
Date Signed: 08/24/2023 01:56:02 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
07/14/2023 and conducted by Evaluator Liridon Fici

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230714152307

FACILITY NAME:	AEGIS ASSISTED LIVING OF FREMONT		FACILITY NUMBER:	015601374
ADMINISTRATOR:	PAUL H SHEPODD		FACILITY TYPE:	740
ADDRESS:	3850 WALNUT AVENUE		TELEPHONE:	(510) 739-1515
CITY:	FREMONT	STATE: CA	ZIP CODE:	94538
CAPACITY:	110	CENSUS: 80	DATE:	07/19/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Shashi Madahar, Administrator		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Illegal Eviction

INVESTIGATION FINDINGS:

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On 7/19/2023 at 9:15 AM Licensing Program Analyst (LPA) L.Fici arrived unannounced to conduct an initial 10-day complaint investigation and to delivery findings in regard to the allegation above. LPA met with Shashi Madahar, Administrator (ADM) and explained the purpose of the visit.

During visit, LPA reviewed residents roster and confirmed with ADM if R1 resides in Aegis Assisted Living of Fremont, and ADM stated R1 does not resides in this facility. This complaint was taken for the facility an error.

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.

Exit interview conducted with ADM, and a copy of this report provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Liridon Fici	TELEPHONE: (510) 359-0768
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

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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