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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700333
Report Date: 01/26/2023
Date Signed: 01/26/2023 03:34:17 PM


Document Has Been Signed on 01/26/2023 03:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:FAIR OAKS ESTATES INCFACILITY NUMBER:
342700333
ADMINISTRATOR:SINGH, GURSHAHBAZFACILITY TYPE:
740
ADDRESS:8845 FAIR OAKS BLVDTELEPHONE:
(916) 944-2077
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:106CENSUS: DATE:
01/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:44 PM
MET WITH:Kirt HamburgTIME COMPLETED:
03:40 PM
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On 1/26/23, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit while present to open a related complaint investigation. LPA spoke with The licensee and several mangers about a resent disturbance of staff and the facility by other staff who are in the process of separation from employment.

Prior to initiating the visit, LPA completed required COVID-19 department protocols. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility.

Prior to today's visit, LPA was notified by a third party of a social media posting by a caregiver that showed a resident in care. Upon arrival, LPA was informed of a great deal more postings and subsequent texts and emails that are threatening current staff. Licensee has notified law enforcement. LPA verified that the Ombudsman is also aware.

During LPA's visit, LPA verified that the facility is clean, safe and sanitary. All resident care needs appear to be met. The investigations are ongoing.

As a result of today’s inspection, no deficiencies were noted.


Report reviewed and copy provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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