079200770-1-24-2025-15-AS-BFOG-DDL3ST-20250204173052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200770
Report Date: 01/24/2025
Date Signed: 01/24/2025 02:09:27 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
01/21/2025 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20250121135027

FACILITY NAME:	ASK ASSISTED LIVING LLC		FACILITY NUMBER:	079200770
ADMINISTRATOR:	SABRINA P. CROWDER		FACILITY TYPE:	740
ADDRESS:	3414 DEER HILL RD		TELEPHONE:	(510) 682-8409
CITY:	LAFAYETTE	STATE: CA	ZIP CODE:	94549
CAPACITY:	6	CENSUS: 5	DATE:	01/24/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Monique Robinson, Administrator Philip Go, Staff (S1)		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff does not ensure facility is kept in clean sanitary conditions
Licensee does not ensure facility is kept free of rodents

INVESTIGATION FINDINGS:

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On 01/24/25 at 12PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced visit, met with staff (S1) and spoke with administrator (ADM) on the phone who authorized S1 to act on her behalf and sign the reports. LPA explained the purpose of the visit with ADM and S1. LPA gathered information on the allegations and delivered the investigation findings to ADM and S1.

At 12:15PM, LPA obtained the following documents from S1: Personnel record (LIC 500), Resident roster, Emergency/Disaster/Infection Control plans, Pest control records.

Continued on next page, LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025

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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Control Number 15-AS-20250121135027

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: ASK ASSISTED LIVING LLC	FACILITY NUMBER: 079200770
	VISIT DATE: 01/24/2025

NARRATIVE

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Allegation: Staff does not ensure facility is kept in clean sanitary conditions
Investigation Finding: Unsubstantiated
On 01/24/25 at 12:30PM, LPA toured the facility and observed the kitchen & counter tops, bathrooms, floors, living rooms, bedrooms, hallways and dining areas clean and odor free. Staff (S1) stated they clean, dust and disinfect facility's kitchen, counter tops, bathrooms, common hallways, dining areas, living room as well as residents' bedrooms twice a day (AM & PM). LPA observed facility to be in good repair, clean and odor free.

Allegation: Licensee does not ensure facility is kept free of rodents
Investigation Finding: Unsubstantiated
On 01/24/25 at 1PM, LPA inspected facility and grounds with S1. LPA checked all residents’ bedrooms, kitchen, bathrooms, living room, dining room, hallways, laundry room and did not observe an rodent feces/droppings inside the facility. Review of Orkin Pest Control service report dated 12/23/24 showed that rodent traps were placed in the living & dining room areas and outside overgrown vegetation cut to eliminate the migration of any pest into the facility. LPA observed no rodents present during visit.

Based on records review, interviews conducted, and observations made, the department has investigated the above allegations and found them to be unsubstantiated. A finding that the complaint allegation is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the above allegations are unsubstantiated.

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

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025

LIC9099 (FAS) - (06/04)

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