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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315001487
Report Date: 05/07/2021
Date Signed: 05/07/2021 04:58:41 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/24/2020 and conducted by Evaluator Todd Tryon
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20200924124021
FACILITY NAME:JABEZ HOMESTEADFACILITY NUMBER:
315001487
ADMINISTRATOR:SAMANTHA CORKERFACILITY TYPE:
740
ADDRESS:1720 LILAC LANETELEPHONE:
(530) 888-8620
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:0CENSUS: 0DATE:
05/07/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kim CavenderTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff yelled at resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/7/2021 LPA Tryon spoke with former licensee Kim Cavender to complete the complaint. LPA met with Ms. Cavender by phone due to concerns related to COVID-19.
LPA has spoken with the administrator, one witness and four former residents. LPA learned that no one had ever heard any of the current staff that were employed at the time of the complaint or in the recent past yell or be disresptful to any of the residents. Resident allegedly involved (R1) did not recall anyone yelling, could not name or describe anyone who had done so.
Therefore, since LPA found no evidence of staff disrespect of or yelling at residents. The allegation is UNFOUNDED.
A finding of UNFOUNDED means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted.
A copy of this Complaint Investigation Report will be forwarded to the former licensee by e-mail. She has been asked to print out 2 copies, sign both, keep one for her records, and return the other copy to CCL for agency facility files. A hard copy will be kept in the file.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
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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