<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608023
Report Date: 03/01/2023
Date Signed: 03/01/2023 04:16:00 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/23/2023 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20230223142837
FACILITY NAME:SUNGATE CARE FACILITYFACILITY NUMBER:
197608023
ADMINISTRATOR:TASHA KANALEYFACILITY TYPE:
735
ADDRESS:3441 SUNGATE DR.TELEPHONE:
(661) 526-7848
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:4CENSUS: 4DATE:
03/01/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Dolly BarrazaTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility administrator is falsifying facility staff certificate(s) training.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/01/2023, Licensing Program Analyst (LPA) Spaeth arrived at the facility to conduct an unannounced complaint visit. Upon arrival, LPA was greeted by four caregivers. LPA conducted an entrance interview, and explained the purpose of the visit. LPA and two caregivers toured the facility from 12:10 pm until 12:25 pm. LPA did not observe any health or safety issues.

It was alleged that the administrator is falsifying faciilty staff certificate(s) training.

To investigate this allegation, LPA Spaeth interviewed four staff members and the Administrator from 12:30 until 1:00 pm.. LPA reviewed residents and staff records from 1:00 pm until 1:30 pm. and requested training documents that are relevant to this investigation.



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20230223142837
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNGATE CARE FACILITY
FACILITY NUMBER: 197608023
VISIT DATE: 03/01/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The complaint had stated a male caregiver had worked at the facility until February 2022. The four caregivers and the Administrator stated the male caregiver mentioned in the complaint did not work at the facility. LPA observed the staff members had completed the DSP1, DSP2, and CPI training. LPA observed the training documents had not been altered. The caregivers also stated the Administrator has never requested caregivers send the CPI, DSP1, and DSP2 certificates to the Administrator so that the Administrator could alter the document and falsify the training records. The Administrator also stated has not asked caregivers to send their training certificates in order to alter the certificates and put another staff member's name on the falsified document.

Therefore the allegation is unsubstantiated. Exit interview conducted and a copy of this report was signed and delivered to facility manager.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2