216802050-8-2-2022-21-AS-HDBI-CGX2NP-20220802173305

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216802050
Report Date: 08/02/2022
Date Signed: 08/02/2022 01:42:36 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/17/2022 and conducted by Evaluator Farhaan Sarangi

COMPLAINT CONTROL NUMBER: 21-AS-20220517165451

FACILITY NAME:	LUCAS VALLEY LODGE		FACILITY NUMBER:	216802050
ADMINISTRATOR:	ANGLADE, GREGOIRE		FACILITY TYPE:	740
ADDRESS:	70 MOUNT TENAYA DRIVE		TELEPHONE:	(415) 377-4888
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	4	CENSUS: 0	DATE:	08/02/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Administrator, Gregoire Anglade		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility is not providing resident copies of their records upon request

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Lucas Valley Lodge for the purpose of delivering complaint findings. LPA was greeted at the door by Administrator, Gregoire Anglade, and was granted access into the facility.

Complaint alleges that the facility is not providing resident copies of their records upon request. During the course of the investigation, an interview was conducted with the Administrator. Resident records were furnished to the appropriate party.

Based on information received during this investigation, the department has found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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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