345002909-12-28-2022-25-AS-LMUZ-CN6UAB-20230117142426

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002909
Report Date: 12/28/2022
Date Signed: 12/28/2022 10:51:02 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2022 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 25-AS-20220825085921

FACILITY NAME:	COGIR OF FOLSOM		FACILITY NUMBER:	345002909
ADMINISTRATOR:	EKUNDARE, ADEBIMPE		FACILITY TYPE:	740
ADDRESS:	1801 EAST NATOMA STREET		TELEPHONE:	(916) 608-0800
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	66	CENSUS: 21	DATE:	12/28/2022
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Administrator, Tracy Lehner		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Facility is not following quarantine protocol
Administrator is not present at facility

INVESTIGATION FINDINGS:

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On 12/28/22, Licensing Program Analysts (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegation listed above and met with Administrator, Tracy Lehner. Prior to visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

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 25-AS-20220825085921

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: COGIR OF FOLSOM	FACILITY NUMBER: 345002909
	VISIT DATE: 12/28/2022

NARRATIVE

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Facility is not following quarantine protocol.
On 8/31/2022 LPA Muscan toured the facility. LPA observed all staff present were wearing masks. Covid signs were observed throughout the facility. This facility was monitored by Community Care Licensing as a Covid-19 positive facility. The facility was following all required Covid-19 positive protocols including but not limited to 10 day quarantine period (which may be extended depending on pending test results for all clients and staff.) Additionally, facility utilizes 2 dining rooms for those positive and those negative residents. Further, facility tries to keep residents in their rooms as much as possible. LPA received documentation of COVID protocol trainings by staff.

This agency has investigated the complaint alleging the facility is not following Covid-19 protocols. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

Administrator is not present at the facility.
The administrator stated that she is on the premises more than enough hours to permit adequate attention to the management and administration of the facility. Records reviewed shows Administrator is at the facility an adequate number of hours. Additionally, the administrator stated that she devotes additional hours in the facility to fulfill her responsibilities when the need for such additional hours is needed.

This agency has investigated the complaint alleging the administrator is not present at the facility. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted with Administrator and a copy of this report was provided to the facility. The signature of Administrator on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC9099 (FAS) - (06/04)

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