270708207-3-19-2022-26-AS-MHON-CDUTYE-20220426150838

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 270708207
Report Date: 03/19/2022
Date Signed: 03/19/2022 09:55:36 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/16/2021 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 26-AS-20210216145129

FACILITY NAME:	CARMEL VILLA		FACILITY NUMBER:	270708207
ADMINISTRATOR:	KATHLEEN S. VORIS		FACILITY TYPE:	740
ADDRESS:	26635 PANCHO WAY		TELEPHONE:	(831) 625-9394
CITY:	CARMEL	STATE: CA	ZIP CODE:	93923
CAPACITY:	6	CENSUS: 5	DATE:	03/19/2022
		UNANNOUNCED	TIME BEGAN:	08:26 AM
MET WITH:	Administrator, Dina Wissinger via telephone		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility did not notify responsible party of resident's change in condition.

INVESTIGATION FINDINGS:

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On 03/19/2022, Licensing Program Analysts (LPAs) L. Salazar and Melinda Medina arrived at the facility unannounced to deliver findings on the above allegation. LPAs were greeted by Staff S1, stated the purpose of visit and were allowed entry into the facility. S1 contacted Administrator who gave permission for S1 to sign report.

Based on interviews and records review, facility had communication logs evidencing facility was in continuous contact with Responsible party for Resident R1. We have found that the complaint was unfounded, meaning that the allegation is false, could not have happened and or is without reasonable basis.

Exit interview conducted with S1. A copy of this report was provided at the time of visit. No deficiencies cited.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2022

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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