336403275-7-30-2021-18-AS-DMUN-C8GVER-20211105162246

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403275
Report Date: 07/27/2021
Date Signed: 07/30/2021 12:13:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/30/2021 and conducted by Evaluator Elecia Weathersby

COMPLAINT CONTROL NUMBER: 18-AS-20210630083153

FACILITY NAME:	PUTTERS LANE ASSISTED LIVING		FACILITY NUMBER:	336403275
ADMINISTRATOR:	COCCHIARO, KAREN EILEEN		FACILITY TYPE:	740
ADDRESS:	43307 PUTTERS LANE		TELEPHONE:	(951) 927-8651
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	6	CENSUS: 3	DATE:	07/27/2021
		UNANNOUNCED	TIME BEGAN:	09:50 PM
MET WITH:	Administrator, Karen Cocchiaro		TIME COMPLETED:	10:14 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

(19) Facility not providing resident's records

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Elecia Weathersby conducted an unannounced facility visit to deliver the findings on the above allegation(s). LPA spoke with Administrator Karen Cocchiaro.

This agency has investigated the following complaint(s) alleging:

Allegation #(1) Facility not providing resident's records.
The investigation consisted of interviews with relevant parties and document reviews.
Insufficient evidence was received to warrant the release of the residents records. Records request are governed by Title 22 regulations and Health and Safety Code. Based on documents and interviews conducted, although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time.

An exit interview was conducted with Administrator, Karen Cocchiaro where this report, LIC 9099 were discussed and provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Elecia Weathersby	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

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 1