342700731-8-1-2024-27-AS-KHOS-D84HD8-20240813060554

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700731
Report Date: 08/01/2024
Date Signed: 08/01/2024 03:49:28 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
07/31/2024 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20240731171458

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: 5	DATE:	08/01/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Cleopatra Gardiner		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Personal Rights: Staff threatened resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced complaint inspection at Love and Comfort Elderly Care RCFE on 8/1/24 at 1:30pm to inform the licensee of complaint allegation mentioned above and to deliver findings.

Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations because all current residents and staff members interviewed denied the allegations. LPA conducted five resident interviews, all residents interviewed denied the allegation and denied witnessing any staff member threaten a resident. LPA conducted two interviews with staff members who both denied the allegation. LPA contacted the placement agency who denied the allegation and provided statements to LPA that former resident was an aggressor with staff members. LPA contacted former resident's parole officer who stated he was unaware of any complaints by former resident and resident has a history of instability in structered placements with a restraining order against the former resident at one placement.

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: 08/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024

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-20240731171458

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: 08/01/2024

NARRATIVE

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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 Personal Rights 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: 08/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024

LIC9099 (FAS) - (06/04)

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