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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005676
Report Date: 06/23/2022
Date Signed: 06/23/2022 12:16:24 PM

Unsubstantiated


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
04/13/2022 and conducted by Evaluator Talwinder Bains
COMPLAINT CONTROL NUMBER: 25-AS-20220413152237
FACILITY NAME:GARDEN VILLAFACILITY NUMBER:
317005676
ADMINISTRATOR:GAODE, ANNAFACILITY TYPE:
740
ADDRESS:3908 RUTLAN WAYTELEPHONE:
(916) 772-1972
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 4DATE:
06/23/2022
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Anna GaodeTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Facility is not following Hospice plan.
INVESTIGATION FINDINGS:
1
2
3
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5
6
7
8
9
10
11
12
13
On 06/23/22, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility and met with Administrator Anna Gaode , to conclude a complaint investigation into the allegation listed above. LPA wore surgical mask and was screened by facility upon entry. Facility staff wore masks while on the premises.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

Allegation: Facility is not following Hospice plan.

** Report continued on 9099-C **
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 25-AS-20220413152237
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: GARDEN VILLA
FACILITY NUMBER: 317005676
VISIT DATE: 06/23/2022
NARRATIVE
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Continued from 9099-----

LPA conducted an investigation for the stated allegation from this complaint. LPA conducted a tour of the facility on 04/19/22 and conducted interviews with administrator and 3 residents. LPA conducted interviews with hospice staff on 04/21/22 and on 05/11/22. LPA gathered and reviewed all hospice notes, medical records and other related documents from facility and hospice agency. LPA interviewed 2 facility staff on 05/12/22 and 05/13/22. Based on resident’s records review, interviews with hospice staff and facility staff, LPA found out that there is no evidence that facility is not following hospice plan as addressed in resident’s file, therefore this allegation is found to be UNSUBSTANTIATED.

Based on interviews conducted by the Department and observation, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
04/13/2022 and conducted by Evaluator Talwinder Bains
COMPLAINT CONTROL NUMBER: 25-AS-20220413152237

FACILITY NAME:GARDEN VILLAFACILITY NUMBER:
317005676
ADMINISTRATOR:GAODE, ANNAFACILITY TYPE:
740
ADDRESS:3908 RUTLAN WAYTELEPHONE:
(916) 772-1972
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 4DATE:
06/23/2022
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Anna GaodeTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff is verbally abusive to residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/23/22, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility and met with Administrator Anna Gaode , to conclude a complaint investigation into the allegation listed above. LPA wore surgical mask and was screened by facility upon entry. Facility staff wore masks while on the premises.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

Allegation: Facility staff is verbally abusive to residents.

** Report continued on 9099-C **
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 25-AS-20220413152237
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: GARDEN VILLA
FACILITY NUMBER: 317005676
VISIT DATE: 06/23/2022
NARRATIVE
1
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3
4
5
6
7
8
9
10
11
12
13
14
15
16
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9099-C (from 9099-A page)------


LPA conducted an investigation for the stated allegation from this complaint. LPA conducted a tour of the facility on 04/19/22 and conducted interviews with administrator, residents, staff and witnesses in regard to verbal abuse at facility. Interviews did not indicate any residents, staff and/or witness observed verbal abuse towards residents. LPA observed while doing facility tour on 04/19/22 that facility staff was very attentive to resident’s needs and did not witness or observed any indication of verbal abuse at this facility. Based on facility tour, interviews and observation, LPA found out that there is no evidence that facility staff is verbally abusive to residents in any nature, therefore this allegation is found 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 was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.



SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4