306006047-11-17-2022-22-AS-LADS-CMSW3E-20230105155548

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006047
Report Date: 11/17/2022
Date Signed: 11/17/2022 10:56:58 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/07/2022 and conducted by Evaluator Jerome Haley

COMPLAINT CONTROL NUMBER: 22-AS-20220907085204

FACILITY NAME:	KNOTT'S LANDING LUXURY CARE		FACILITY NUMBER:	306006047
ADMINISTRATOR:	RAJPOOT, FAISAL		FACILITY TYPE:	740
ADDRESS:	6359 ARNOLD WAY		TELEPHONE:	(949) 290-1826
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY:	6	CENSUS: 5	DATE:	11/17/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Faisal Rajpoot		TIME COMPLETED:	11:05 AM

ALLEGATION(S):

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Facility failed to make telephone accessible to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to deliver the findings on the complaint allegation above. LPA identified himself and discussed the purpose of the visit with staff.
The investigation into the allegation “Facility failed to make telephone accessible to resident.” revealed the following:
During the initial visit September 8, 2022, LPA Haley interviewed Administrator (AD) Faisal Rajpoot, facility staff, and residents. LPA received information from multiple residents and multiple staff that contradicts the allegation above. Information received from AD Rajpoot, multiple residents, staff, and the Reporting Party (RP) contradict the allegation above. Further, LPA Haley received documentation that contradict the allegation above.
Based on the information gathered during the investigation, observation, and document review, the following allegation: Facility failed to make telephone accessible to resident is deemed Unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

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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