342700554-9-16-2021-25-AS-MSEY-C6XP6F-20210917110213

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700554
Report Date: 09/16/2021
Date Signed: 09/16/2021 04:08:56 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
08/10/2021 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 25-AS-20210810131036

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: 5	DATE:	09/16/2021
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Angie Crudo, Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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-Resident is not allowed to move out of facility.

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 into the allegation that resident is not allowed to move out of facility. LPA wore an N95 mask and was screened upon entry in the care home. All staff wore masks in the care home. There are no COVID positive cases at the facility.

According to interview with Administrator, resident (R1) had expressed interest in moving out of the care home and Administrator offered to assist in finding placement to another assisted living facility. Administrator stated that R1 wanted to move to an independent living facility as opposed to an assisted living facility. Administrator provided LPA with copy of a handwritten notice dated 7/7/21, which was provided to the Administrator by R1, indicating R1 would be moving out of the facility by 8/7/21. R1 did not move out of the facility by 8/7/21 and,

************************************************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: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

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 25-AS-20210810131036

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: 09/16/2021

NARRATIVE

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according to the Administrator, refused assistance with finding placement to another facility. As of 8/30/21, R1 signed discharge documentation from the facility and was discharged to the home of a family member.

Based on interviews conducted and records reviewed, 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: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

LIC9099 (FAS) - (06/04)

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