079200882-8-13-2021-15-AS-KHOS-C73LCK-20210921083828

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200882
Report Date: 08/13/2021
Date Signed: 08/13/2021 09:42:25 AM

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
12/16/2019 and conducted by Evaluator Lizette Francisco

COMPLAINT CONTROL NUMBER: 15-AS-20191216134758

FACILITY NAME:	CHERISH CARE HOME INC.		FACILITY NUMBER:	079200882
ADMINISTRATOR:	OKEIGWE, OGEDI		FACILITY TYPE:	740
ADDRESS:	15 DICKSON LANE		TELEPHONE:	(925) 250-3044
CITY:	MARTINEZ	STATE: CA	ZIP CODE:	94553
CAPACITY:	6	CENSUS: 2	DATE:	08/13/2021
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Winifred Wepee, Back-up Administrator		TIME COMPLETED:	09:50 AM

ALLEGATION(S):

1
2
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9

Facility does not have on call night staff.

INVESTIGATION FINDINGS:

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13

On 8/13/2021 starting at 9:05am, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to deliver findings for the above allegation. Upon arrival, LPA met with Care Staff, Renny Lumi. Back-up Administrator, Winifred Wepee later arrived at 9:25am.

During the course of the investigation, LPA P. Singh conducted 10-day initial investigation on 12/19/2019. On 8/11/2021, LPA L. Francisco interviewed S1 over the phone and obtained and requested a copy of facility's Personnel Report (LIC 500) via email for October 2019 to December 2019. Based on record review, a night shift staff is scheduled to work from 7pm-7am. No forthcoming information provided by reporting party.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette Francisco	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

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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