<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002377
Report Date: 06/14/2022
Date Signed: 06/14/2022 04:35:37 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, 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
02/16/2022 and conducted by Evaluator Jaclyn Avila
COMPLAINT CONTROL NUMBER: 25-AS-20220216162604
FACILITY NAME:BRIGHTHAVEN HOME FOR ELDERLYFACILITY NUMBER:
045002377
ADMINISTRATOR:KRISTINE ABEJOFACILITY TYPE:
740
ADDRESS:3064 CEANOTHUS AVETELEPHONE:
(530) 809-0418
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:6CENSUS: 4DATE:
06/14/2022
UNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:Kristine AbejoTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff grabbed resident
Staff denied resident with access to phone
Staff intimidates resident(s)
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/14/2022 at approximately 3:00 PM, Licensing Program Analyst (LPA) Jaclyn Avila arrived at the facility unannounced to conduct a complaint investigation. LPA met with Licensee/Administrator Kristine Abejo and explained the purpose of the visit. Prior to initiating the complaint investigation, LPA completed required COVID-19 testing protocol and self screened to ensure no COVID-19 related symptoms: LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95.

The Department received a complaint regarding the above allegations. The department has conducted interviews, reviewed documents and toured the facility. Although the resident states incident occurred no others who reside or are associated to the home can corroborate the allegations.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn AvilaTELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3