079200513-6-9-2023-15-AS-KHOS-CT6JSM-20230626071833

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200513
Report Date: 06/09/2023
Date Signed: 06/09/2023 02:24:50 PM

Unfounded

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
05/22/2023 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20230522142044

FACILITY NAME:	WELCOME HOME SENIOR RESIDENCE (CONCORD 2)		FACILITY NUMBER:	079200513
ADMINISTRATOR:	STEVEN CHOU		FACILITY TYPE:	740
ADDRESS:	807 WEAVER LANE		TELEPHONE:	(510) 685-8388
CITY:	CONCORD	STATE: CA	ZIP CODE:	94518
CAPACITY:	6	CENSUS: 5	DATE:	06/09/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Ivee Regalado		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not provide 60-day notice prior to rent increase

INVESTIGATION FINDINGS:

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On 06/09/2023 starting at 01:45 pm, Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct complaint investigation for the above allegation. LPA spoke with house manager, Clara Delgado and explained the purpose of the visit. Clara designated Ivee Regalado to sign off on the report.

On the allegation facility tsaff did not provide 60-day notice prior to rent increase. Based on record review and interviews the facility provided a 2-day stating a change of condition of the resident. A case management will be conducted on the 2-day notice that was given.

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.

Exit interview conducted with Administrator and a copy of this report provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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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