019201063-12-13-2023-15-AS-HHUL-CYVTUK-20231226140225

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201063
Report Date: 12/13/2023
Date Signed: 12/13/2023 04:55:04 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
08/17/2023 and conducted by Evaluator Grace Luk

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230817132333

FACILITY NAME:	AEGIS GARDENS		FACILITY NUMBER:	019201063
ADMINISTRATOR:	POON, EMILY		FACILITY TYPE:	740
ADDRESS:	36281 FREMONT BLVD		TELEPHONE:	(949) 488-2669
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	85	CENSUS: 76	DATE:	12/13/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Emily Poon, Senior General Manager		TIME COMPLETED:	05:11 PM

ALLEGATION(S):

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Staff charged residents for services not received.

INVESTIGATION FINDINGS:

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On 12/13/2023 at 2:45PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct complaint investigation and to deliver complaint findings for the allegation above. LPA met with Health Services Director, Gigi Tamayo and explained the purpose of the visit. Senior General Manager, Emily Poon arrived an hour later.

During the investigation, LPA L. Fici interviewed staff and representatives of residents. LPA L. Fici obtained billing states for six residents. On 12/13/2023, LPA G. Luk interviewed 4 staff and reviewed documents (service delivery records, notice to resident/family during outbreaks, activities during outbreaks).

On 8/24/2023, LPA L. Fici has indicated that residents were not being charged for tray services during the three COVID outbreaks. LPA L. Fici reviewed six resident's statement invoices which revealed no tray service charges to the residents.
(Continue on LIC9099C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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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Control Number 15-AS-20230817132333

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: AEGIS GARDENS	FACILITY NUMBER: 019201063
	VISIT DATE: 12/13/2023

NARRATIVE

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On 12/13/2023, LPA G. Luk interviewed staff which revealed that escort services were provided to residents. S4 stated that facility was providing small group activities during the 3 COVID outbreaks. S4 stated that residents were escorted to small group activities and walks in the courtyard area. LPA G. Luk reviewed a sample of resident's service delivery records and observed that residents were provided escort services during the 3 COVID outbreaks. Facility emailed residents and family during each COVID outbreak which indicates that dining room will be closed; However, there will be small group activities and exercise in the courtyard was provided. LPA observed activity schedule where small groups activities were conducted at different times.

Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore these allegation is UNSUBSTANTIATED.

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC9099 (FAS) - (06/04)

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