342700782-9-2-2021-25-AS-LMUZ-C6HSJC-20210903135454

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700782
Report Date: 09/02/2021
Date Signed: 09/02/2021 04:23:35 PM

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
04/14/2021 and conducted by Evaluator Danyle Wolter

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210414165418

FACILITY NAME:	7121 MAIN, LLC		FACILITY NUMBER:	342700782
ADMINISTRATOR:	COLEMAN, ROBERT		FACILITY TYPE:	740
ADDRESS:	7121 MAIN AVE		TELEPHONE:	(707) 592-4004
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	6	CENSUS: 5	DATE:	09/02/2021
		UNANNOUNCED	TIME BEGAN:	03:35 PM
MET WITH:	Gladys Gasta, staff		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Facility opened resident's mail without authorization.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wolter arrived at the facility unannounced on 09/02/2021 to deliver complaints findings for the allegation listed above. LPA met with staff Gladys Gasta and explained the purpose of the visit. Prior to initiating the 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask.

The department conducted interviews relevant to the allegation: Facility opened resident's mail without authorization. Resident interviews revealed conflicting information regarding the allegation; facility staff interviewed stated that resident’s mail is not opened, and that they have completed training on resident’s rights.

Report continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Danyle Wolter	TELEPHONE: (916) 708-5307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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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Control Number 25-AS-20210414165418

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: 7121 MAIN, LLC	FACILITY NUMBER: 342700782
	VISIT DATE: 09/02/2021

NARRATIVE

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Facility recently conducted Personal Rights training to all staff employed to ensure resident’s personal rights are not violated.

Due to this information the Department finds the allegation of Facility opened resident's mail without authorization to be UNSUBSTANTIATED. A finding that the complaint allegation is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conducted and copy of report left at facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Danyle Wolter	TELEPHONE: (916) 708-5307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

LIC9099 (FAS) - (06/04)

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