317005900-7-24-2020-27-AS-LMUZ-BRXT9J-20200728143202

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 317005900
Report Date: 07/24/2020
Date Signed: 07/24/2020 01:44:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/30/2020 and conducted by Evaluator Sarena Keosavang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200630131530

FACILITY NAME:	MEADOW OAKS OF ROSEVILLE		FACILITY NUMBER:	317005900
ADMINISTRATOR:	JASMINE RIDENOUR		FACILITY TYPE:	740
ADDRESS:	930 OAK RIDGE RD		TELEPHONE:	(916) 774-0200
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95661
CAPACITY:	108	CENSUS:	DATE:	07/24/2020
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Jasmine Ridenour		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Uncleared adult present at the facility.

INVESTIGATION FINDINGS:

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On 7/24/2020, Licensing Program Analyst (LPA) Sarena Keosavang contacted the facility via telephone to commence a complaint investigation finding via telephone due to COVID-19 and pre-cautionary measures. LPA discussed the purpose of the call and the elements of the allegation with Jasmine Ridenour, Administrator.

During the complaint investigation, LPA Keosavang opened a complaint alleging an uncleared adult present at the facility on 7/3/2020. LPA requested for pertinent documents such as staff’s (S1) Criminal Record Exemption Transfer Request documents, facility staff roster, and termination letter. LPA reviewed S1’s Personnel History Information on Licensing Information System (LIS). On 2/18/2020, S1 was associated to Meadow Oaks of Roseville. On 4/15/2020, a Case Closure Notice was sent to the facility stating that the Department has ceased processing the background check for S1. Licensing received noticed that S1 must be removed from the facility by 4/30/2020.

*********************************************** Continue on LIC 9099C ***********************************************

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2020

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-20200630131530

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: MEADOW OAKS OF ROSEVILLE	FACILITY NUMBER: 317005900
	VISIT DATE: 07/24/2020

NARRATIVE

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LPA interviewed Administrator regarding S1’s employment status. Administrator stated the facility submitted S1’s transfer of Criminal Record Clearance Exemption on 2/26/2020. On 4/22/2020, the facility received documentation that S1’s case was closed. S1 emailed the Department of Social Services (DSS Webmaster) to ask for an extension for the exemption clearance. Administrator sent the Email between S1 and DSS Webmaster to LPA for review. According to the Email that LPA reviewed from DSS Webmaster, there was no response to the exemption-needed letter from S1 or the facility and the case has been closed. S1 was advised to start the process again by reprinting, and once the Caregiver Background Check Bureau (CBCB) receives the new information from the Department of Justice, the case will be reassigned to another analyst and a new exemption-request letter will be sent. On 4/22/2020, on the same day the facility received the Case Closure Notice management suspended S1 due to individual did not receive a criminal record clearance. The facility must immediately remove S1 from the facility and prevent S1 from having contact with clients. On 4/23/2020, the facility processed his termination request form.

Based on statement and documents provided. This agency has investigated the complaint alleging, an uncleared adult working at the facility. The Department have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis.

Exit interview conducted and a copy of report along was sent via e-mail.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2020

LIC9099 (FAS) - (06/04)

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