315001893-5-10-2021-27-AS-LMUZ-C372F2-20210519172049

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315001893
Report Date: 05/10/2021
Date Signed: 05/10/2021 10:17:46 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
08/26/2020 and conducted by Evaluator Konnor Leitzell

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200826083920

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:	10:30 AM
MET WITH:	Andrew Makanoneug (Admin)		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not ensure residents were properly fed
Staff is verbally abusive to residents

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 did not ensure residents were properly fed”, due to COVID-19 and precautionary measures the findings were delivered via telephone. LPA spoke to Administrator.

Throughout the course of the investigation; the department conducted interviews and reviewed documentation related to the allegations. LPA Leitzell conducted interviews for both staff and residents. The department conducted a field visit as well to view food supply at facility. Food supply was viewed to have three (3) days worth of perishable and seven (7) days worth of nonperishable. When interviewing residents, it was determined residents are provided full meals for breakfast, lunch and dinner; including snacks between meals.

Cont. LIC 9099C

Unfounded

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-20200826083920

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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LPA interviewed two (2) of three (3) residents, and 2 of 2 staff regarding the alleged verbal abuse. Both residents denied verbal abuse occurring at facility. Both staff indicated no verbal abuse is occurring.

Through the course of the investigation, the above allegations are found to be UNFOUNDED-An allegation that is considered invalid because the evidence shows it could not have happened, is false, and/or is without a reasonable basis.

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 is to 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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