342700843-9-6-2023-27-AS-KHOS-CVLQNZ-20230912121957

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700843
Report Date: 09/06/2023
Date Signed: 09/06/2023 03:47:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
08/17/2023 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230817171937

FACILITY NAME:	PADUA ASSISTED LIVING 2		FACILITY NUMBER:	342700843
ADMINISTRATOR:	DAYOAN, ANGELITA		FACILITY TYPE:	740
ADDRESS:	2929 BABSON DRIVE		TELEPHONE:	(279) 333-7621
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	6	CENSUS: 5	DATE:	09/06/2023
		UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Angelita Dayoan		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Resident was hit by staff member
Staff member attempted to hit resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Angelita Dayoan and explained the purpose of the visit.

This investigation consisted of observation, interviews with staff, residents, and a local police officer, as well as review of facility records.

LPA Moleski interviewed four staff members. Four of these (S1-S4) said they were not aware of any violence at the facility and did not have any concerns in this area. S1 denied hitting residents or attempting to do so. Three of five residents interviewed (R2-R4) were not aware of any violence at the facility and/or did not share concerns in this area. R1 said that S1 hit R2, and attempted to hit R1. R5 said that S1 has pushed R2.
[continued on 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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-20230817171937

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: PADUA ASSISTED LIVING 2	FACILITY NUMBER: 342700843
	VISIT DATE: 09/06/2023

NARRATIVE

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LPA Moleski did not observe any unusual marks, such as bruising or lacerations, on R1 or R2.

LPA Moleski interviewed a local police officer who responded to allegations of physical abuse at this facility on August 17, 2023. The officer said R1 was not aware of any allegations of abuse at the time of the police visit, and R2 did not have any marks visible. The officer did not believe the allegations were substantiated based on the information obtained by police.

The department has determined the following as it relates to the allegations that a resident was hit by a staff member and a staff member attempted to hit a resident:

Based on interviews with staff members, residents and with a local police officer, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Dayoan.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC9099 (FAS) - (06/04)

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