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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701116
Report Date: 07/05/2023
Date Signed: 07/06/2023 10:29:59 AM

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
05/16/2023 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230516150830
FACILITY NAME:LAKEWOOD VILLAFACILITY NUMBER:
342701116
ADMINISTRATOR:QUIAMBAO, GLADYSFACILITY TYPE:
740
ADDRESS:8708 GERBER ROADTELEPHONE:
(925) 954-5329
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:18CENSUS: 14DATE:
07/05/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Gladys QuiambaoTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not providing resident with comfortable accommodations.
Staff spoke inappropriately towards resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/06/2023 at 10:15 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at this facility to conduct a complaint visit. LPA Lee met with administrator, Gladys Quiambao and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.

Throughout the course of this investigation, the Department conducted interviews, reviewed facility files, and reviewed medical documents.

Allegation: Staff are not providing resident with comfortable accommodations
It was alleged that the facility is not providing resident with comfortable accommodations. LPA Lee conducted 10 resident interviews. 8 out of 10 residents stated that they don’t have issues with the facility staff not providing comfortable accommodations at this time. Two residents stated that they enjoy living at this facility because they feel safe and are able to talk to the facility staff like their own family. LPA Lee was unable to interview 3 other residents due to residents not verbal. In addition, LPA Lee was also not able to interview 3 other residents due to language barrier. It is unclear that the facility did not provide resident with comfortable accommodations at this time.

Allegation: Staff spoke inappropriately towards resident.
It was alleged that facility staff spoke inappropriately toward residents. LPA Lee conducted 10 residents’ interviews. 9 out of 10 residents stated that they don’t have any concerns and have not witness staff speaking inappropriately towards residents at this time. It is unclear that the facility staff are speaking to residents inappropriately toward residents at this time.

As a result of this investigation, and based on LPA’s observations, and interviews the allegations are deemed to be UNSUBSTANTIATED - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, the preponderance of evidence standards has not been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies are being cited.

An exit interview was conducted, and a copy of this report was provided to the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
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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