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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700573
Report Date: 02/10/2022
Date Signed: 02/10/2022 03:20:51 PM

Unsubstantiated


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
10/29/2021 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 25-AS-20211029163025
FACILITY NAME:AKUA BEHAVIORAL HEALTH INC IVFACILITY NUMBER:
342700573
ADMINISTRATOR:BEZDEK, SEANFACILITY TYPE:
772
ADDRESS:10821 & 10827 FAIR OAKS BLVDTELEPHONE:
(916) 903-7028
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:14CENSUS: DATE:
02/10/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sean BezdekTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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-Food is not in the quantity necessary to meet the needs of the clients
-Food is not of quality necessary to meet the needs of the clients
-Facility is out of ratio
INVESTIGATION FINDINGS:
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On (Day/Time), Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with clinical staff. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Upon arrival, completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask. Additionally, LPA was screened with temperature at the facility.

LPAs conducted records review and extensive interviews.
The department is unable to find and or meet the preponderance, per policy.

Menus reviewed and Interviews conducted did not support the allegations that food is not in the quantity necessary to meet the needs of the clients nor that food is not of quality necessary to meet the needs of the clients. Some residents interviewed did state preferences that some different foods be offered but not that quality or quantity were insufficient.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 25-AS-20211029163025
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: AKUA BEHAVIORAL HEALTH INC IV
FACILITY NUMBER: 342700573
VISIT DATE: 02/10/2022
NARRATIVE
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Interviews conducted and records reviewed do not support that Facility fails to maintain the required staff ratio. Title 22 CCR states 81065.5 Day Staff Client Ratio ...(a)(3) All facilities shall employ staff and have staffing patterns and ratios as indicated on the facility certification document. The Department of Health Care services (DHCS) in turn requires 1 staff equivalent per 2.5 clients (additional staff may be needed for identified client needs) . DHCS review of facility staffing on Dec , 2021 found the facility to meet the required staffing at that time.

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.


Exit interview conducted and report copy provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2