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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001224
Report Date: 08/02/2022
Date Signed: 08/02/2022 11:38:38 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/01/2022 and conducted by Evaluator DeAnna Williams-Lyons
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220601163309
FACILITY NAME:ETTYS' CAREFACILITY NUMBER:
347001224
ADMINISTRATOR:ETELKA GINGAFACILITY TYPE:
740
ADDRESS:8840 CENTRAL AVENUETELEPHONE:
(916) 988-5713
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 6DATE:
08/02/2022
UNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Gianina Ginga, CaregiverTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility does not provide a safe environment for the residents.
INVESTIGATION FINDINGS:
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On 8/2/2022, Licensing Program Analyst (LPA) DeAnna Williams-Lyons, arrived at the facility unannounced to conduct a Complaint Investigation Visit. LPA conducted COVID-19 Precautionary prescreening and wore a surgical mask while at facility.
LPA investigated the allegation “Facility does not provide a safe environment for the residents.” LPA conducted interviews and reviewed provided documentation.

Resident #2 (R2) has a diagnosis of Dementia. R2 lives in the facility with husband, resident #1 (R1) who has POA (Power of attorney) over R2. Complaint investigation revealed that R1 takes R2 out in the community to a local bar. Interviews indicated that R1 will drive with R2 back to facility after leaving the bar.

To continue see 9099-C...
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
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 25-AS-20220601163309
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: ETTYS' CARE
FACILITY NUMBER: 347001224
VISIT DATE: 08/02/2022
NARRATIVE
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R1 does have power of attorney for his wife and can leave the facility unassisted and take R2 with him. R1 has been encouraged not to leave the facility and frequent the bars with R2.

Facility staff have communicated R1’s behavior with physician and family of the residents. R1 and R2 are adults and if R2 wants to leave with R1, the facility cannot prevent the outing. Based upon this investigation LPA has determined the facility has provided a safe environment for the residents. LPA observed facility to be in good repair inside and outside. Since this complaint has been filed with the Department, R2 no longer is leaving the facility with R1 to go to local bars.

“This agency has investigated the complaint alleging. “Facility does not provide a safe environment for the residents” We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not happened and/or is without a reasonable basis."

Per California Code of Regulation, Title 22, No citations were issued.

An exit interview was conducted and a copy of this report was given to Giaina.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2