107206629-12-11-2024-24-AS-SMOA-DC8LNG-20241223075418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206629
Report Date: 12/11/2024
Date Signed: 12/11/2024 01:22:03 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/03/2024 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20241203151721

FACILITY NAME:	ELIM PLACE		FACILITY NUMBER:	107206629
ADMINISTRATOR:	WOLF, RACHEL E.		FACILITY TYPE:	740
ADDRESS:	1808 5TH STREET		TELEPHONE:	(559) 875-7268
CITY:	SANGER	STATE: CA	ZIP CODE:	93657
CAPACITY:	44	CENSUS: 27	DATE:	12/11/2024
		UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Christina Gomez (Assistant Executive Director) and Executive Director; Maria Ceballos		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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9

Uncleared adult worked at facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) K. Kaur arrived at the facility unannounced to conduct an initial 10-day complaint inspection. LPA met with Christina Gomez, AED (Assistant Executive Director) and explained the purpose of the visit and reviewed the elements of the allegations. Executive Director; Maria Ceballos; arrived a short while later. LPA delivered the following complaint investigation findings.

The Department investigated the allegations listed above. Based on observations, interviews and record review there is no uncleared adult working at facility. Therefor the Department has found that the complaint is UNFOUNDED meaning that the allegations were false, could not have happened, and/or without a reasonable basis.

No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to Executive Director, whose signature on the form confirms receipt of this document.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

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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