342700902-12-11-2023-59-AS-LMUZ-CYRRE2-20231222115648

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700902
Report Date: 12/11/2023
Date Signed: 12/11/2023 11:21:25 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
12/07/2023 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20231207150457

FACILITY NAME:	FOLSOM COUNTRYHOUSE		FACILITY NUMBER:	342700902
ADMINISTRATOR:	LETICIA FERMOSO HIGARES		FACILITY TYPE:	740
ADDRESS:	2005 IRON POINT RD		TELEPHONE:	(916) 836-8022
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	60	CENSUS: 46	DATE:	12/11/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator, Danielle Peck		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility elevator is in disrepair.

INVESTIGATION FINDINGS:

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On 12/11/23, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to do complaint investigation into the allegation listed above and met with administrator, Danielle Peck and explained the reason of today's visit.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.Based on interviews and records reviewed, the elevator broke on 12/05/23 and facility reached out same day to company who will repair it. Per facility records and interviews, elevator sensor was broken and new sensor will arrive around 12/12/23 and service company will complete all the repair work . Although the elevator was temporarily not in service, the plan to get residents downstairs was implemented and therefore the allegation is unsubstaniated, as there was no harm caused to residents in care. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Exit interview was conducted with administrator and a copy of this report was provided to the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

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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