342700554-6-11-2021-27-AS-MSEY-C3YVNJ-20210614163513

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700554
Report Date: 06/11/2021
Date Signed: 06/11/2021 03:04:09 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
11/16/2020 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 27-AS-20201116140829

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:	DATE:	06/11/2021
		UNANNOUNCED	TIME BEGAN:	02:57 PM
MET WITH:	Angie Crudo, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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-Facility staff threatened resident
-Facility staff are not providing a safe environment for resident

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 allegations listed above. 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.

During the course of the investigation, LPA conducted visits to the care home and observed staff checking on residents in care and assisting when needed. LPA interviewed staff and resdients in care as well. Interviews with residents (R1, R4, R5, R6) and staff (S1) indicated that they have never noticed staff threatening or mistreating residents in care. Interviews also indicated that they have never seen any altercations with staff and residents.

**********************************************Continued on LIC9099-C*************************************************

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: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

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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Control Number 27-AS-20201116140829

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ANGIES CARE HOME	FACILITY NUMBER: 342700554
	VISIT DATE: 06/11/2021

NARRATIVE

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Interviews with R1, R3, R4, R5, and R6 indicated that they are all being treated well, all their care needs are being met, and that they like living at the care home. The Department was not provided direct evidence regarding the above stated allegations.

Based on interviews conducted, 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.

Exit interview conducted.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

LIC9099 (FAS) - (06/04)

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