315001689-1-25-2023-25-AS-LMUZ-CNPTJX-20230203134703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315001689
Report Date: 01/25/2023
Date Signed: 01/25/2023 01:50:41 PM

Unsubstantiated

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
02/03/2022 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 25-AS-20220203173801

FACILITY NAME:	TAJ RESIDENTIAL CARE II		FACILITY NUMBER:	315001689
ADMINISTRATOR:	IGOR KOSTHANDINOVIC		FACILITY TYPE:	740
ADDRESS:	8289 HORNCASTLE AVENUE		TELEPHONE:	(916) 772-1547
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	6	CENSUS: 6	DATE:	01/25/2023
		UNANNOUNCED	TIME BEGAN:	01:46 PM
MET WITH:	IGOR KOSTHANDINOVIC, Administrator		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Conduct inimical

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Mirlohi arrived on Wednesday January 25, 2023 to deliver findings regarding the above allegation. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.
The Department conducted an investigation regarding the allegation listed above. Based on the investigation, there is insufficient information to determine whether the licensee coerced staff working at the facility to work under unsafe labor practices therefore the allegations of conduct inimical are unsubstantiated.
Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated.

An exit interview was conducted. A copy of the report was provided to facility administrator.

Unsubstantiated

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: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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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