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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045001495
Report Date: 07/28/2022
Date Signed: 07/28/2022 02:04:17 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
07/21/2022 and conducted by Evaluator Jaclyn Avila
COMPLAINT CONTROL NUMBER: 25-AS-20220721100304
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:
07/28/2022
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Amy CookTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility air conditioner is not working
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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.

On 7/5/2022, this Department conducted an investigation and cited the facility due to the air conditioner not working. The POC for the citation was to bring in a portable AC until the air conditioner could be fixed. The Licensee agreed. The AC was fixed on July 22nd, 2022. The reported temperature was 85 degrees F which is within regulation. Licensee agrees to maintain the temperature not only within Regulation but at a temperature that is comfortable for the clients. Licensee agrees to make adjustments to meet the comfort levels of the clients.Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED Although the allegation is substantiated no citation will be issued due to the licensee being previously cited on 7/5/2022 and due to the Licensee activily working on fixing the unit.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Jaclyn Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
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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