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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001986
Report Date: 12/05/2022
Date Signed: 12/05/2022 11:07:25 AM

Unsubstantiated


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
08/29/2022 and conducted by Evaluator Tung Truong
COMPLAINT CONTROL NUMBER: 27-AS-20220829084507
FACILITY NAME:SOL EDNAVE CARE HOMEFACILITY NUMBER:
347001986
ADMINISTRATOR:SOLEDAD EDNAVEFACILITY TYPE:
735
ADDRESS:8434 SUNRISE WOODS WAYTELEPHONE:
(916) 681-2546
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:5CENSUS: 5DATE:
12/05/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lyn Manugo TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Physical abuse resulting in client sustaining injuries
Staff threatened client
Staff are not providing a comfortable environment for client
INVESTIGATION FINDINGS:
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On 12/5/22, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit to this facility to deliver the investigation findings. LPA identified himself and discussed the purpose of the visit and the elements of the allegation(s) with Administrator Designee Lyn Manugo.

Throughout the course of the investigation, the Department conducted interviews and reviewed medical records. Regarding the allegation of staff physically abused client resulting in client sustaining injuries, the investigation revealed that R1 has provided inconsistent statements of the abuse. According to R1’s medical records, it was indicated that there were no signs of physical abuse noted except self-inflected excoriation marks. Moreover, Nurse Practitioner Neda Afshar reported that the marks on R1’s back were self-inflicted.

Report continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
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 27-AS-20220829084507
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: SOL EDNAVE CARE HOME
FACILITY NUMBER: 347001986
VISIT DATE: 12/05/2022
NARRATIVE
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The allegation of staff threatened client, LPA did not find any evidence to support the allegation. Based on interviews conducted, 2 out of 3 clients stated that staff have never threatened them or do they feel threatened by staff. The interviews determined that staff or clients have not seen any staff threatened any clients.

The allegation of staff are not providing a comfortable environment for client, LPA did not find any evidence to support the allegation. Based on interviews conducted, 2 out of 3 clients stated that they feel comfortable and safe in the facility.

This Department has investigated the allegations noted above and have found the complaint to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted and copy of report left at facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2