075601508-10-20-2021-15-AS-KHOS-C9CP3H-20211203095734

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601508
Report Date: 10/20/2021
Date Signed: 10/20/2021 05:06:47 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
10/18/2021 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20211018150726

FACILITY NAME:	CORTONA PARK		FACILITY NUMBER:	075601508
ADMINISTRATOR:	AGUSTIN SAMANIEGO		FACILITY TYPE:	740
ADDRESS:	150 CORTONA WAY		TELEPHONE:	(925) 240-0733
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	150	CENSUS: 100	DATE:	10/20/2021
		UNANNOUNCED	TIME BEGAN:	04:10 PM
MET WITH:	Sangeeta Devi & Agustin Sanmaniego		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility's heater is in disrepair

INVESTIGATION FINDINGS:

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

On 10/20/2021 Licensing Program Analyst, (LPA) L. Ibo conducted the investigation regarding the above allegation. LPA met with Administrator Agustin Sanmaniego and nurse Sangeeta Devi, LPA explained the purpose of the visit.

LPA conducted inspection of the first-floor common area; LPA checked thermostat, it was observed that it was set at 76 degrees Fahrenheit. LPA observed fireplace was on at the lobby area for additional heat. LPA visited random residents’ apartment, LPA observed the following; on apartment 217 the thermostat was set for 71 degrees Fahrenheit, apartment 211 thermostat was set for 75 degrees Fahrenheit & apartment 209 the thermostat was set for 76 degrees Fahrenheit.

...Continued on LIC9099C...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

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 2

Control Number 15-AS-20211018150726

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: CORTONA PARK	FACILITY NUMBER: 075601508
	VISIT DATE: 10/20/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA conducted interview with R1, according to R1 she is comfortable with the heater on her apartment, and if she needed help adjusting the thermostat, she calls the facility staff for assistance.

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.

No deficiencies cited.

Exit Interview conducted and a copy of this report provided to administrator.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2