275294322-5-19-2023-24-AS-MHON-CRYT6Z-20230519142754

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275294322
Report Date: 05/19/2023
Date Signed: 05/19/2023 10:36:59 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
01/04/2023 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20230104164412

FACILITY NAME:	PARK LANE, THE		FACILITY NUMBER:	275294322
ADMINISTRATOR:	MONTELLANO, ANTHONY		FACILITY TYPE:	740
ADDRESS:	200 GLENWOOD CIR		TELEPHONE:	(831) 373-0101
CITY:	MONTEREY	STATE: CA	ZIP CODE:	93940
CAPACITY:	160	CENSUS: 75	DATE:	05/19/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Beau Ayers, Acting Executive Director		TIME COMPLETED:	10:17 AM

ALLEGATION(S):

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9

Facility is not properly addressing scabies in the facility.

INVESTIGATION FINDINGS:

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13

On 05/19/23, Licensing Program Analyst (LPA) L. Salazar, delivered findings on the above allegation to Acting Executive Director.

During the investigation, LPA conducted interviews and records review. Medical records reviewed, show Resident R1's medical condition was not scabies and was not a contagious skin condition. R1 has been under, and has continued to be under a physician's care since September of 2022.

Based on the information received, we have found that the complaint was Unfounded, meaning that the allegation is without reasonable basis, therefore, we have dismissed the complaint.

Exit interview conducted. A copy of this report was provided via email to acting Executive Director. An electronic read receipt confirms receiving the report. Facility representative signature on file. No deficiencies cited.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

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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