312700574-2-2-2023-25-AS-TORZ-CP43YS-20230215174024

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700574
Report Date: 02/02/2023
Date Signed: 02/02/2023 09:49:51 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/17/2023 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 25-AS-20230117160355

FACILITY NAME:	ANSEL PARK SENIOR LIVING COMMUNITY		FACILITY NUMBER:	312700574
ADMINISTRATOR:	DEBORAH TAYLOR		FACILITY TYPE:	740
ADDRESS:	1200 ORCHID DRIVE		TELEPHONE:	(916) 250-0770
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95765
CAPACITY:	100	CENSUS: 85	DATE:	02/02/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Deborah Taylor, Administrator		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility failed to provide Hot water.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Mirlohi arrived on Thursday February 2, 2023 to deliver complaint findings regarding the above allegations. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.
During the complaint investigation LPA reviewed receipts, interviewed administrator, and tested the water temperature. Administrator stated they had hot water issues starting on January 16th. Maintenance director arranged for a plumbing company to come out to the facility on January 16th. The plumbing company came out on January 16th and fixed the issue. LPA tested the hot water in 3 bathrooms and observed hot water in all apartments
Due to the information gathered, LPA finds the allegation to be UNFOUNDED.
Exit interview conducted and copy of report given.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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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