075601508-2-2-2023-15-AS-KHOS-CP2RNW-20230214121102

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601508
Report Date: 02/02/2023
Date Signed: 02/02/2023 02:00:14 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, 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
08/30/2021 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20210830150949

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: 93	DATE:	02/02/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Amanda Martino, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility did not adhere to admissions agreement

INVESTIGATION FINDINGS:

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On 02/02/2023, Licensing Program Analysts (LPA) L. Ibo arrived unannounced to deliver complaint findings for the above allegation. LPA met with Amanda Martino, Administrator and explained the reason for the visit.

During the course of investigation, LPA conducted interview and records review. Based on records review, R1 was admitted at the facility in March 2021, based on admissions agreement R1’s invoice was $5,840.00 with no care services rendered. LPA attempted to gather additional documents, but the facility went through transition and was bought by new company (Cogir of Brentwood) and according to the Administrator all the files were taken by the old company (Cortona Park) and no longer available for review. LPA attempted to interview R1, but R1 no longer live at the facility. LPA do not have enough documents to use for investigation.

Although the allegation may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Exit interview conducted with Kudip Singh and Amanda Martino. A copy of this report provided.

Unsubstantiated

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: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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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