315001893-5-10-2021-27-AS-KHOS-C38KSY-20210521081018

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315001893
Report Date: 05/10/2021
Date Signed: 05/10/2021 10:12:15 AM

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
07/23/2020 and conducted by Evaluator Konnor Leitzell

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200723121326

FACILITY NAME:	SWANLAKE VILLA		FACILITY NUMBER:	315001893
ADMINISTRATOR:	AWUY, IVONNE		FACILITY TYPE:	740
ADDRESS:	9702 SWAN LAKE DRIVE		TELEPHONE:	(916) 797-8521
CITY:	GRANITE BAY	STATE: CA	ZIP CODE:	95746
CAPACITY:	6	CENSUS: 3	DATE:	05/10/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Andrew Makanoneug (Admin)		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff yelled at resident
Staff handled resident in a rough manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Konnor Leitzell contacted the facility via telephone to deliver complaint finding for the allegations listed above, “Staff handled resident in a rough manner” and “Staff yelled at resident”. Due to COVID-19 and precautionary measures the findings were delivered via telephone. LPA spoke to Administrator.

During the course of the investigation, CCL conducted interviews and reviewed documents pertaining to staff yelling at resident. During the investigation process, LPA also visited the property to determine distance from the house to sidewalk to better understand the allegation. Based on the far distance between the sidewalk and front door, LPA determined R1 would not have heard staff if they did not raise their voice initially.
Cont. LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Konnor Leitzell	TELEPHONE: (916) 708-9618
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021

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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Control Number 27-AS-20200723121326

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SWANLAKE VILLA	FACILITY NUMBER: 315001893
	VISIT DATE: 05/10/2021

NARRATIVE

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Through interviews conducted with staff who were involved; LPA was informed staff did raise their voice initially when calling out to R1 in order to get their attention, but began lowering it when approaching the resident. Through reviewing documents while at the facility, LPA discovered R1 suffers from hearing loss. Due to information gathered through the course of this investigation, LPA finds the purpose for staff raising their voice to the resident to be to provide help, with no malicious intent.

During the investigation process, LPA conducted interviewed and reviewed documents regarding staff handling the resident in a rough manner. Through interviews conducted with the responding Sheriff, as well as reviewed the Police Report LPA discovered no evidence of staff handling the resident's in a rough manner. During interviews conducted at facility, there was no evidence to suggest staff handled the resident in a rough manner. LPA Leitzell was able to determine there in insufficient evidence to state R1 was handled in a rough manor.

Through the investigation process, LPA is able to determine the allegations above to be UNSUBSTANTIATED – A finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conducted. Copy of report sent to the facility via e-mail, Administrator to sign and return a copy to CCL either by fax or email, a copy should be retained for facility records as well.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Konnor Leitzell	TELEPHONE: (916) 708-9618
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021

LIC9099 (FAS) - (06/04)

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