342700731-9-5-2024-27-AS-KHOS-D9DKP9-20240923080421

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700731
Report Date: 09/05/2024
Date Signed: 09/05/2024 03:18:30 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2024 and conducted by Evaluator Kevin Gould

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240828140255

FACILITY NAME:	LOVE AND COMFORT ELDERLY CARE		FACILITY NUMBER:	342700731
ADMINISTRATOR:	SHARP, KAYDIA		FACILITY TYPE:	740
ADDRESS:	6532 RANCHO GRANDE WAY		TELEPHONE:	(916) 594-9378
CITY:	SACRAMNETO	STATE: CA	ZIP CODE:	95828
CAPACITY:	6	CENSUS: 4	DATE:	09/05/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Isikeli Tuikentatuba		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Sexual Abuse: Resident was sexually assaulted while in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Kevin Gould and department representative Shariff Osman made an unannounced inspection to Love and Comfort Elderly Care RCFE on 9/5/24 at 9:00am to conclude the investigation of the above allegation and to deliver the findings. LPA Gould met with staff, Isikeli Tuikentatuba and together discussed the investigation details.

Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. The alleged victim made contradictory statements to Long term care ombudsman, department investigators and law enforcement. LPA Gould attempted to conduct additional interview with alleged victim, however they had left the facility prior to LPAs arrival and the service coordinator states they have refused further service and their whereabouts are unknown at the time of writing. Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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-20240828140255

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LOVE AND COMFORT ELDERLY CARE	FACILITY NUMBER: 342700731
	VISIT DATE: 09/05/2024

NARRATIVE

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Alleged perpetrator denied allegations and expressed frustration with the allegations. LPA observed alleged perpetrator with two broken legs and currently cannot bear weight on legs without assistance. Staff interviewed by the department stated they have never witnessed residents interacting or alone together at any point of their stay at the facility.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Sexual abuse are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies is cited per California Code of Regulations, TITLE 22.

Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC9099 (FAS) - (06/04)

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