342701168-1-18-2024-27-AS-KHOS-CZRRRY-20240123121554

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701168
Report Date: 01/18/2024
Date Signed: 01/18/2024 01:58:37 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
01/02/2024 and conducted by Evaluator Tung Truong

COMPLAINT CONTROL NUMBER: 27-AS-20240102091555

FACILITY NAME:	YOUNG AT HEART RCFE NO.3 INC		FACILITY NUMBER:	342701168
ADMINISTRATOR:	SISAYAN, LILLIAN		FACILITY TYPE:	740
ADDRESS:	9375 BROWNSBERG WAY		TELEPHONE:	(916) 681-3689
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95829
CAPACITY:	6	CENSUS: 6	DATE:	01/18/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	John Trapse		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility staff handled resident in a rough manner.
Facility staff fed a resident food that had dropped on the floor.

INVESTIGATION FINDINGS:

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On 1/18/24, Licensing Program Analyst (LPA) Tung Truong arrived at the facility unannounced to deliver complaint findings. LPA met with facility staff John Trapse and explained the purpose of today visit.

Throughout the course of this investigation, LPA Truong conducted interviews and reviewed facility documents. It was learned this allegation pertained to a resident that has never lived at Young at Heart No.3.

As a result of this investigation, LPA finds the allegations above to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis.

Exit interview was conducted and a copy of the report was provided upon exit.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

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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