019200464-11-30-2022-15-AS-KHOS-CLUN8X-20221206091503

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200464
Report Date: 11/30/2022
Date Signed: 11/30/2022 11:59:18 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
09/13/2022 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20220913155756

FACILITY NAME:	J & C CARE CENTER LLC		FACILITY NUMBER:	019200464
ADMINISTRATOR:	CHING, JESSICA		FACILITY TYPE:	740
ADDRESS:	4240 REDDING STREET		TELEPHONE:	(510) 482-0108
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94619
CAPACITY:	25	CENSUS: 18	DATE:	11/30/2022
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Jessica Ching, Admistrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff are not allowing resident in care to receive services as prescribed by their physician.

INVESTIGATION FINDINGS:

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On 11/30/2022 at 11:50AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to deliver findings for the above allegation. Upon arrival, LPA met with Jessica Ching Administrator, and explained the purpose of the visit.

During the course of the investigation, LPA obtained information, interviewed staff and residents. Based on information obtained, Staff are allowing resident in care to receive services as prescribed by their physician.
Based on interview with residents, 3 of 3 residents states that the staff do allow them to received services that are prescribed by their physician.

Although the allegations may have happened or are valid, there are not preponderance of evidence to provide the alleged violation did occur, therefore the allegations are UNSUBSTANTIATED.

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

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022

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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