342700471-11-30-2022-25-AS-APEZ-CM2PRW-20221212103326

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700471
Report Date: 11/30/2022
Date Signed: 11/30/2022 03:56:49 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
11/23/2022 and conducted by Evaluator Sarena Keosavang

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20221123170735

FACILITY NAME:	COGIR OF STOCK RANCH		FACILITY NUMBER:	342700471
ADMINISTRATOR:	DAVID JR., RICKY		FACILITY TYPE:	740
ADDRESS:	7418 STOCK RANCH RD		TELEPHONE:	(916) 725-7418
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	99	CENSUS: 64	DATE:	11/30/2022
		UNANNOUNCED	TIME BEGAN:	03:04 PM
MET WITH:	Executive Director- Ricky David		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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- Facility fire alarm is in disrepair.

INVESTIGATION FINDINGS:

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On 11/30/2022 at 3:00 PM, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced and met with Executive Director (ED), Ricky David, to open a complaint investigation into the allegation listed above. LPA wore N-95 mask and were screened by facility staff prior to entering the facility.

During today’s visit, LPA requested documentation pertinent to the investigation and interviewed ED. ED stated Fire Department was present at the facility to test fire alarm system and observed the functions and reporting of the system was inaccurate on 11/22/2022. ED stated the facility did their due diligence and hired a third-party company (Assurance Security) to conduct fire watch log daily. The facility submitted fire watch logs to the Fire Department daily for review.

Continue on page LIC9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022

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 25-AS-20221123170735

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: COGIR OF STOCK RANCH	FACILITY NUMBER: 342700471
	VISIT DATE: 11/30/2022

NARRATIVE

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ED explained fire alarm is working but the issue is the sub panel, but the rest of the panels throughout the community is operable. ED stated the repair will take about a week. ED agrees to submit fire watch log to LPA daily until fire alarm system has been repair.

Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED; However due to the facility's due diligence no citation will be given to the facility. Facility will be monitored by LPA.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022

LIC9099 (FAS) - (06/04)

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