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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045001495
Report Date: 07/05/2022
Date Signed: 07/05/2022 03:40:03 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/28/2022 and conducted by Evaluator Jaclyn Avila
COMPLAINT CONTROL NUMBER: 25-AS-20220628131524
FACILITY NAME:VILLA KRISTINAFACILITY NUMBER:
045001495
ADMINISTRATOR:COOK, AMYFACILITY TYPE:
735
ADDRESS:83 SKYMOUNTAIN CIRCLETELEPHONE:
(530) 809-4371
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:6CENSUS: 5DATE:
07/05/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Amy Cook, Licensee/AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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 The air conditioner is not working.
INVESTIGATION FINDINGS:
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The Department met with Amy Cook, Administrator unannounced regarding the allegation above. Licensing Program Analyst (LPA) Jaclyn Avila completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID 19 infection to affirm no COVID-19 related symptoms. LPA Avila ensured that hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95.

Administrator confirmed that the air conditioner is not and has not been working since 6/28/2022. On 6/28/2022 the recorded outdoor tempature was 100 degrees Farienhiet. Administrator has been working with the insurance to fix the AC however it has not happened to date. During a tour of the facility at approximately 2:55 PM, indoor temprature was 82 degrees farienhiet. On todays date 7/5/2022, the expected high is 90 degrees farienhiet. The only circulation being provided are ceiling fans. Tempatures are expected to get hotter as the week goes on.
Based on LPAs observations and interviews the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Jaclyn Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022
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 25-AS-20220628131524
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: VILLA KRISTINA
FACILITY NUMBER: 045001495
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/05/2022
Section Cited
CCR
80087(a)
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80087 Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by: Based upon observation and
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Licensee agrees to immediately bring in portable AC units into the facility by COB on 7/5/2022. Licensee will provide LPA with receipts and pictures of units operating in the facility.
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interview the Licensee failed to maintain the air conditioner in good repair.

This poses an immediate health and safety risk for all residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Jaclyn Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2