019200922-4-27-2022-15-AS-KHOS-CEGJ7V-20220516064833

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200922
Report Date: 04/27/2022
Date Signed: 04/27/2022 05:15:05 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
01/21/2021 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20210121090211

FACILITY NAME:	CASA SANDOVAL		FACILITY NUMBER:	019200922
ADMINISTRATOR:	ROSANA FRIAS		FACILITY TYPE:	740
ADDRESS:	1200 RUSSELL WAY		TELEPHONE:	(510) 727-1700
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	99	CENSUS: 50	DATE:	04/27/2022
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Rosana Frias, Associate Executive Director		TIME COMPLETED:	05:20 PM

ALLEGATION(S):

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Facility is unsafe due to construction

INVESTIGATION FINDINGS:

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On 4/18/2022 at 3:45PM, Licensing Program Analyst (LPA), L. Hall arrived unannounced to conduct complaint investigation and deliver complaint findings for the allegation above. LPA met with Rosana Frias, Associate Executive Director (ED) and explained the reason for the visit.

During the investigation LPA. A. Delmundo interviewed staff, Reporting Party (RP), and witness LPA L. Hall interviewed residents on today's visit. W1 stated during the interview the scaffolding is checked everyday to ensure safety and the ladders are folded and locked underneath the scaffolding when not in use. Staff 3 (S3) stated an additional elevator was added March 2021 for more convenience for the residents, and it will remain after the renovation.

Continued on LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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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Control Number 15-AS-20210121090211

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: CASA SANDOVAL	FACILITY NUMBER: 019200922
	VISIT DATE: 04/27/2022

NARRATIVE

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Continued from LIC9099.

Interviews with R2, R4, and R5 indicated they have felt safe during the renovation and the elevators have been working normal. LPA observed residents walking outside in common area and it didn't appear the scaffolding was obstructing or unsafe for the residents. LPA also timed the elevator from one floor to another when button was pushed. It took 30 seconds for the elevator to come from the 2nd floor to the 1st floor. LPA observed 3 elevators throughout the facility. Residents in care appear to be safe and there are no imminent health/safety concerns on today's date.

Based upon the interviews and observations during the investigation the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and a copy of report was given.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

LIC9099 (FAS) - (06/04)

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