317000716-5-19-2021-25-AS-MSEY-C38KX5-20210521081659

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 317000716
Report Date: 05/19/2021
Date Signed: 05/19/2021 12:35:58 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
04/29/2021 and conducted by Evaluator Bethany Huusfeldt

COMPLAINT CONTROL NUMBER: 25-AS-20210429144534

FACILITY NAME:	ELIM GLEN		FACILITY NUMBER:	317000716
ADMINISTRATOR:	LEE, EDWARD INCHUL		FACILITY TYPE:	740
ADDRESS:	6257 EUREKA ROAD		TELEPHONE:	(916) 791-9451
CITY:	GRANITE BAY	STATE: CA	ZIP CODE:	95746
CAPACITY:	20	CENSUS: 18	DATE:	05/19/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Farah Cuccia, Assistant Administrator		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Facility not meeting resident's dietary needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Huusfeldt-Mirlohi arrived unannounced to continue investigation into allegation listed above. LPA met with administrator Farah Cuccia during today's inspection.
LPA investigated allegation "Facility not meeting resident's dietary needs". LPA toured the facility and observed the kitchen area. LPA observed fresh vegetables, fruits, meats, dairy items, and canned items. LPA observed no expired foods and a sufficient 2 day perishable and 7 day non-perishable amount of food. LPA reviewed food menus, and grocery receipts, and observed a variety of different food options. Administrator stated they currently do not have any residents with dietary restrictions. LPA interviewed 3 residents in which they stated the meals have improved and they receive a variety of food options. Residents stated they are satisfied with the meals being provided. Due to the information gathered, LPA finds allegation to be UNFOUNDED. The allegation is UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.
Exit interview conducted.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021

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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