075600760-3-25-2021-15-AS-KHOS-BZMMMU-20210331094430

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075600760
Report Date: 03/25/2021
Date Signed: 03/25/2021 09:20:54 AM

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
03/01/2021 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20210301122614

FACILITY NAME:	HEAVENLY CARE, LLC		FACILITY NUMBER:	075600760
ADMINISTRATOR:	HUGHES, FELECIA		FACILITY TYPE:	740
ADDRESS:	2700 LOTUS COURT		TELEPHONE:	(925) 978-0496
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	6	CENSUS: 4	DATE:	03/25/2021
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Felecia Hughes, Administrator		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Illegal eviction of resident

INVESTIGATION FINDINGS:

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On 03/25/21 at 9:10AM, Licensing Program Analyst (LPA) Daisy Panlilio conducted a tele-visit with administrator to deliver the finding of the complaint investigation. Due to COVID-19 shelter in place, administrator was not physically available to sign this report.

Based on record reviews and interviews, administrator assisted resident (R1), provided care and supervision to R1 while at the facility & during stays at two hospitals in February & March 2021. She did not abandon R1 during this whole process and was willing to take her back at the facility once her condition was stable.

We have found that this complaint is unfounded, meaning the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed this complaint. Exit interview conducted and a copy of this report provided via email.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Rajind Basi	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

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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