079200174-8-26-2022-15-AS-KHOS-CHTLZR-20220831091221

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200174
Report Date: 08/26/2022
Date Signed: 08/26/2022 05:45:16 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
08/25/2022 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20220825162834

FACILITY NAME:	LINDA'S RESIDENTIAL CARE, LLC		FACILITY NUMBER:	079200174
ADMINISTRATOR:	ERLINDA PORTILLO		FACILITY TYPE:	735
ADDRESS:	4605 MENDOTA WAY		TELEPHONE:	(925) 565-5106
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	6	CENSUS: 5	DATE:	08/26/2022
		UNANNOUNCED	TIME BEGAN:	04:49 PM
MET WITH:	Luis Fernandez, Administrator		TIME COMPLETED:	06:15 PM

ALLEGATION(S):

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Facility has insects

INVESTIGATION FINDINGS:

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On 08/26/22 at 4:49PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced complaint visit, met with administrator (ADM) and staff (S1), gathered relevant information on the allegations and delivered the investigation findings.

Allegation: Facility has insects
Investigation Finding: Unsubstantiated
During visit, LPA toured the facility with staff (S1). LPA did not observe any ants on the walls, floors, windows, doors in common areas, bedrooms, bathrooms and kitchen. LPA also did not observe any ants on each clients' clothes or person. Administrator showed LPA Ortho and Raid insect sprayers staff use to eliminate and control any insect infestation at the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided via email.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

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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