097002991-5-14-2021-25-AS-MSEY-C2ZVXL-20210514164942

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 097002991
Report Date: 05/14/2021
Date Signed: 05/14/2021 11:16:27 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/07/2021 and conducted by Evaluator Melissa Lusby

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210507143953

FACILITY NAME:	NEW WEST HAVEN II		FACILITY NUMBER:	097002991
ADMINISTRATOR:	JOEL MATKOVICH		FACILITY TYPE:	740
ADDRESS:	2551 CAMEO LANE		TELEPHONE:	(530) 677-2979
CITY:	CAMERON PARK	STATE: CA	ZIP CODE:	95682
CAPACITY:	67	CENSUS: 21	DATE:	05/14/2021
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Kimberly Rimert, Resident Services Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Air conditioner is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst Melissa Lusby arrived at the facility on Friday May 14, 2021 to deliver findings for the complaint investigation. LPA wore an N95 as part of covid-19 precautions. LPA identified herself to Kimberly Rimert and discussed the elements of the allegation. Throughout the investigation, the Department conducted relevant party interviews, obtained relevant documentation and evidence, and conducted a facility tour. While one of the facility's large air conditioner is not working properly, the facility has done the following: offered to move affected residents to another room, begun repairs, and maintained the inside temperature of the facility to below 80 degrees. The Department finds the allegation of the air conditioner in disrepair to be UNSUBSTANTIATED. A finding that the complaint allegation is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Melissa Lusby	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021

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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