342700583-5-9-2022-27-AS-KHOS-CEGUCZ-20220516152843

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700583
Report Date: 05/09/2022
Date Signed: 05/09/2022 06:07:45 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/18/2022 and conducted by Evaluator Avelina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220218100311

FACILITY NAME:	CHATEAU ON CAPITOL AVENUE, THE		FACILITY NUMBER:	342700583
ADMINISTRATOR:	TYLER BARNES		FACILITY TYPE:	740
ADDRESS:	2701 CAPITOL AVENUE		TELEPHONE:	(916) 447-4444
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95816
CAPACITY:	81	CENSUS: 20	DATE:	05/09/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Tyler Barnes		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility is having issues with plumbing.
Facility windows are not sealed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced on 05/09/2022 at 9:00 am to deliver complaint findings, LPA met with Administrator, Tyler Barnes, and explained the purpose of the visit.

Throughout the course of the investigation, LPA Martinez conducted interviews and tours of the facility. During a facility tour, LPA Martinez inspected resident rooms on the 6th floor, and there are no windows in resident rooms only glass sliding doors. The other resident rooms on different floors have no windows and also have glass sliding doors. Some sliding doors were not in good repair, and LPA Martinez cited the facility on April 29, 2022. A plan of correction was implemented, and can be found on the April 29, 2022 809 report. LPA Martinez toured 5 resident rooms, and inspected and tested kitchen sinks, bathroom sinks, and toilets. All kitchen sinks, bathroom sinks, and toilets were in good repair. Additionally, kitchen plumbing has been repaired, and is in good repair, and 5 out of 5 residents reported no issues with plumbing. Due to the above noted information, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, and therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022

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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