342700554-6-4-2021-27-AS-MSEY-C3RSWD-20210607141409

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700554
Report Date: 06/04/2021
Date Signed: 06/04/2021 04:34:08 PM

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
01/05/2021 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 27-AS-20210105141225

FACILITY NAME:	ANGIES CARE HOME		FACILITY NUMBER:	342700554
ADMINISTRATOR:	CRUDO, ANGELINA		FACILITY TYPE:	740
ADDRESS:	8558 SHERATON DR		TELEPHONE:	(916) 962-2460
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	6	CENSUS: 6	DATE:	06/04/2021
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Angie Crudo, Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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-Licensee canceled resident's ride for medical appointment.
-Staff not administering medications as prescribed by physician.
-Licensee does not treat resident with dignity.
-Facility does not provide food of the quality to meet the needs of the residents.
-Facility is operating over capacity.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Administrator, Angie Crudo, to deliver findings in the above listed allegations. Facility currently does not have any COVID-19 positive cases. LPA wore N95 mask and was screened by facility upon entry. Facility staff wore masks in the care home.

Upon speaking with the relevant party, it was discovered that they did not file a complaint against the care home. A Declaration was completed by the relevant party indicating that the above listed allegations are not true or accurate.

Based on interview conducted with relevant party, the above allegations are found to be UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021

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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