075601316-11-2-2020-15-AS-KHOS-BVAPHM-20201112102009

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601316
Report Date: 11/02/2020
Date Signed: 11/02/2020 09:37:08 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
10/22/2020 and conducted by Evaluator Praveen Singh

COMPLAINT CONTROL NUMBER: 15-AS-20201022162920

FACILITY NAME:	SUNNYVALE CARE HOME II		FACILITY NUMBER:	075601316
ADMINISTRATOR:	PURUGANAN, ISABELITA		FACILITY TYPE:	740
ADDRESS:	1836 SUNNYVALE AVENUE		TELEPHONE:	(925) 932-8572
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94597
CAPACITY:	6	CENSUS: 3	DATE:	11/02/2020
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Isabelita Puruganan, Administrator		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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-Staff locked resident's in facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Praveen Singh conducted this unannounced tele-visit with Administrator Isabelita Puruganan to open investigation and deliver findings on the above allegation. Due to the present shelter in place order by the Governor, this inspection was conducted via video-conference.

It was alleged that the facility was using a door stopper to lock residents inside the facility during the night. Pictures were obtained of the door in question with emphasis on the top right hinge of the door. During today's inspection, LPA conducted interviews and observed the specific door in question. LPA observed through demonstration that the item on the hinge of the door was in fact a door protector, preventing the door from slamming into the wall.

This agency has investigated the complaint allegation. 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.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Praveen Singh	TELEPHONE: (510) 622-2625
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2020

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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