342700835-12-15-2022-27-AS-KHOS-CMZRDT-20230112115629

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700835
Report Date: 12/15/2022
Date Signed: 12/15/2022 03:14:53 PM

Unfounded

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
11/17/2022 and conducted by Evaluator Jamie Ivey-Canady

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20221117162602

FACILITY NAME:	CITY CREEK ASSISTED LIVING		FACILITY NUMBER:	342700835
ADMINISTRATOR:	CALEB SUMMERHAYS		FACILITY TYPE:	740
ADDRESS:	6254 66TH AVENUE		TELEPHONE:	(916) 393-2324
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	121	CENSUS: 109	DATE:	12/15/2022
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Katelyn Becker		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Resident touched a resident in an inappropriately sexual manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA)s Jamie Ivey Canady arrived at the facility unannounced to deliver complaint investigation findings. LPA Ivey Canady explained the purpose of the visit and was met by Health Services Supervisor.
The investigation conducted by Investigations Branch revealed this complaint was filed in error for this facility. Based on findings, this facility is not the facility where incident occurred.

The Department has determined the following as it relates to the allegations: Resident touched a resident in an inappropriately sexual manner. Due to the information gathered the Department finds the allegation to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Per the California Code of Regulations, Title 22 no violations were observed during this visit. Exit interview held, copy of report given.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-Canady	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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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