347001970-2-27-2023-27-AS-KHOS-CPFMSB-20230227085141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001970
Report Date: 12/01/2022
Date Signed: 02/27/2023 08:39:14 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, 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
11/02/2022 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20221102103332

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: 55	DATE:	12/01/2022
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Coreen Tigley		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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9

Facility staff are retaining resident's that require a higher level of care

INVESTIGATION FINDINGS:

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AMENDED TO CHANGE FINDINGS SEE NEW 9099. THIS FINDING REMAINS THE SAME.
Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct an investigation of the above mentioned allegations on 12/1/22 at 12:15pm. LPA met with Coreen Tigley and stated the purpose of the visit. LPA received a resident and staff roster with contact information durng this visit. LPA conducted interviews of residents (R1- R4) and staff (S1-S16). Based on interviews conducted there are no residents needing a higher level of care residing in the facility at this time. 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, Div 6, Ch 8, no violations cited during this visit. Exit interview conducted copy given.

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: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

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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