347001970-8-9-2022-27-AS-KHOS-CJGKKH-20220921075821

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001970
Report Date: 08/09/2022
Date Signed: 08/09/2022 01:25:32 PM

Unfounded

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
08/04/2022 and conducted by Evaluator Victoria Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220804100057

FACILITY NAME:	WATERLEAF AT LAND PARK, THE		FACILITY NUMBER:	347001970
ADMINISTRATOR:	CIMINO, PAUL		FACILITY TYPE:	740
ADDRESS:	966 43RD AVENUE		TELEPHONE:	(916) 394-9400
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95831
CAPACITY:	78	CENSUS: 56	DATE:	08/09/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Ana Lobo, Care Coordinator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Resident was left unsupervised for an extended period of time while in care.
Resident wandered from the facility while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 8/9/22 at 12:00pm to investigate the above mentioned allegations. LPA was met by Ana Lobo, Resident Care Coordinator and stated the purpose of the visit. LPA interviewed staff #1 (S1, S2, S4 and resident #1(R1) during this visit.
The investigation revealed that R1 did not leave the property and was met by staff within minutes in the gated staff parking lot. The time frame was confirmed by video surveillance. Based on interviews and observation of the surrounding area of the facility property, the preponderance of evidence standards has not been met. “This agency has investigated the complaint alleging, the above-mentioned allegation(s). We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.”

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were cited during this visit. An exit interview was conducted and a copy of this report was provided.

Unfounded

Estimated Days of Completion: 30

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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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