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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347002709
Report Date: 11/08/2021
Date Signed: 04/27/2022 09:24:54 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
10/12/2021 and conducted by Evaluator Jacob Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20211012113058
FACILITY NAME:A TLC HOMEFACILITY NUMBER:
347002709
ADMINISTRATOR:POP, AURICAFACILITY TYPE:
740
ADDRESS:7338 CROSS DRIVETELEPHONE:
(916) 725-2008
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 4DATE:
11/08/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Aurica PopTIME COMPLETED:
10:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not properly supervise residents
Uncleared adults residing in the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Williams conducted this complaint visit with Aurica Pop, in order to close out the above allegation. Prior to initiating this 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 he applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

During the inspection, LPA investigated the allegations "Licensee does not properly supervise residents". LPA toured the facility and interviewed three out of the four tenants. It is determined that there are no RCFE clients living in the facility; there are only tenants renting as a part of a room and board. None of the four residents are receiving any care or supervision. The allegation of Uncleared adults residing in the facility was deemed unfounded as there were no current residents residing in the home.

Based upon the information obtained during investigation, the above allegations are unfounded. A finding that the complaint is unfounded means that the allegation was false, could not have happened and/or is without a reasonable basis. Copy of this report provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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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