075601281-5-20-2021-15-AS-KHOS-C3CJS6-20210525071750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601281
Report Date: 05/20/2021
Date Signed: 05/20/2021 03:10:40 PM

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
05/18/2021 and conducted by Evaluator Luisa Fontanilla

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20210518161327

FACILITY NAME:	QCARE RESIDENTIAL FACILITY II		FACILITY NUMBER:	075601281
ADMINISTRATOR:	CUNANAN, JOAQUIN		FACILITY TYPE:	740
ADDRESS:	4363 FAIRWOOD DRIVE		TELEPHONE:	(925) 676-8727
CITY:	CONCORD	STATE: CA	ZIP CODE:	94521
CAPACITY:	6	CENSUS: 6	DATE:	05/20/2021
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Joaquin Cunanan		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident care needs are not being met
Authorized representatives were not notified of hospitalization

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On this day at around 10:55 am, Licensing Program Analysts (LPAs) Luisa Fontanilla and Carol Fowler conducted a televisit and met with Administrator Joaquin Cunanan. LPAs explained to Cunanan the purpose of the visit.

During the visit, LPAs interviewed Staff 1 (S1). LPAs were informed by S1 that R1 does not live at this location. Administrator confirmed with LPAs that R1 does not live at this location. Administrator added that R1 has moved to the other location three years ago.

This agency has investigated the above complaints. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

A copy of this report will be sent to Administrator via email.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa Fontanilla	TELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2021

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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