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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700651
Report Date: 11/05/2021
Date Signed: 11/05/2021 04:56:41 PM



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
08/30/2021 and conducted by Evaluator Tirzah Hubbard
COMPLAINT CONTROL NUMBER: 27-AS-20210830142543
FACILITY NAME:PADUA ASSISTED LIVINGFACILITY NUMBER:
342700651
ADMINISTRATOR:PADUA, NICHOLASFACILITY TYPE:
740
ADDRESS:7019 MCGILL COURTTELEPHONE:
(916) 647-3483
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:6CENSUS: 5DATE:
11/05/2021
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Licensee Angelita DayoaTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit Resident.

Resident was not provided with adequate incontinence care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA)s Tirzah Hubbard conducted an unannounced complaint visit on 11-05-2021 and was met by the facility Licensee Angelita Dayoa to discuss the findings of the complaint.
Current census of the facility was:6
The purpose of this visit was to complete this complaint investigatiom and deliver the findings to this facility. Based on interviews and information gathered during the course of this investigation, it was revealed that the facility staff did not hit R1. Based on interviews and records review, it was learned the facility provides adequate care for all persons in care. Based on an interview with responsible party the facility provides adequate care at all times.
In addition, interviews conducted with Licensee and Residents, concluded that the staff ensure all persons in care are safe and staff do not hit resdients.

The preponderance of evidence standards has been met. Therefore, the allegation was deemed to be UNFOUNDED. A copy of this report will be mailed to property address.
Unfounded
Estimated Days of Completion: 30
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tirzah HubbardTELEPHONE: 559-365-5294
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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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