275294322-4-3-2022-26-AS-KHOS-CDERM5-20220412130811

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275294322
Report Date: 04/03/2022
Date Signed: 04/03/2022 05:11:10 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,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/23/2020 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 26-AS-20201123091455

FACILITY NAME:	PARK LANE, THE		FACILITY NUMBER:	275294322
ADMINISTRATOR:	BEAU A. AYERS		FACILITY TYPE:	740
ADDRESS:	200 GLENWOOD CIR		TELEPHONE:	(831) 373-0101
CITY:	MONTEREY	STATE: CA	ZIP CODE:	93940
CAPACITY:	160	CENSUS: 194	DATE:	04/03/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Lori Trindade Sales Director		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff did not properly reassess resident
Resident's room smelled foul
Resident's was room unsanitary and not clean
Staff did not meet residents needs
Staff threatened residents with eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 4/3/22 at 12:00pm to conclude the complaint investigation. Upon arrival LPA met with Lori Trindade Sales Director and stated the purpose of the visit. Lori Trindade contacted the Administrator Beau Ayers via phone and LPA requested a call from the Administrator. The Administrator contacted LPA who restated the purpose of the visit.

Regarding allegation, "Staff did not properly reassess resident", "Resident's room smelled foul", "Resident's room unsanitary and not clean", "Staff did not meet residents needs", "Staff threatened residents with eviction" LPA reviewed files for residents during this visit. LPA was not able to interview R1 nor R2 due to the fact that they moved from the facility. During interviews of staff, LPA obtained information that neither of the residents received a written eviction notice. In meeting with the residents and responsible parties, as an option, the Administrator mentioned that if the facility is not allowed to care for R1 properly for wandering behavior and the pets (cats and dogs) that reside in the the room is not maintained properly an eviction process will need to be considered. LPA did not observe an assesment for R1 to reside in the Memory Care Unit.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2022

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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Control Number 26-AS-20201123091455

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: PARK LANE, THE	FACILITY NUMBER: 275294322
	VISIT DATE: 04/03/2022

NARRATIVE

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Based on interviews conducted today and the lack of evidence, the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be UNSUBSTANTIATED.

A finding that the complaint 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.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2022

LIC9099 (FAS) - (06/04)

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