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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701130
Report Date: 05/10/2022
Date Signed: 05/10/2022 02:56:00 PM

Unsubstantiated


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
02/28/2022 and conducted by Evaluator Tung Truong
COMPLAINT CONTROL NUMBER: 27-AS-20220228121758
FACILITY NAME:COMFORTS OF HOME GAVIRATEFACILITY NUMBER:
342701130
ADMINISTRATOR:PARAS, FAITHFACILITY TYPE:
740
ADDRESS:9823 GAVIRATE WAYTELEPHONE:
(510) 414-7828
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:6CENSUS: 6DATE:
05/10/2022
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Rhonda RigginsTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Resident is not allowed telephone calls.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tung Truong arrived at the facility unannounced on 5/10/22 at 2:15 pm to conclude the investigation of the above allegation and to deliver the findings. Upon LPAs arrival, Caregiver Rhonda Riggins was present at facility and contacted Administrator Faith Paras. LPA spoke with Administrator Faith Paras on the phone and explained the purpose of today's visit. LPA informed Faith of the complaint's findings. Administrator advised that Rhonda can sign the report.

Throughout the course of the investigation, LPA conducted interviews and reviewed records. Based on statements obtained, it was learned that residents were allowed to make phone calls. 3 out of 4 resident interviewed stated staff assist with making phone calls to family. Furthermore, interviews with resident’s family revealed that they have no issues with getting in touch with the resident when calling the facility phone.

Report continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 27-AS-20220228121758
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: COMFORTS OF HOME GAVIRATE
FACILITY NUMBER: 342701130
VISIT DATE: 05/10/2022
NARRATIVE
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Based on information obtained, the Department finds the allegation above to be UNSUBSTANTIATED- 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 and a copy of this report was provided.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2