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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347004385
Report Date: 05/23/2024
Date Signed: 05/23/2024 02:12:43 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/06/2023 and conducted by Evaluator DeAnna Williams-Lyons
COMPLAINT CONTROL NUMBER: 59-AS-20231006120838
FACILITY NAME:LARCHMONT MANORFACILITY NUMBER:
347004385
ADMINISTRATOR:MARIA YELDONFACILITY TYPE:
735
ADDRESS:7336 LARCHMONT DR.TELEPHONE:
(916) 993-6389
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:6CENSUS: 3DATE:
05/23/2024
UNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Maria Yeldon, AdministratorTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff speaks inapropriatly to resident
Staff threatens resident
INVESTIGATION FINDINGS:
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On May 23 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to deliver findings for complaint# 59-2023100612083. LPA met with Maria Yeldon, Licensee and informed her the reason for the visit.
Throughout the investigation, LPA reviewed facility notes, conducted interviews with resident and staff, and made observations. LPA interviewed four staff and two residents who all report that they have never witnessed any residents being threatened or spoken to inappropriately. Three out of four staff report they have never had any issues with residents being threatened or mistreated in any way. In addition, no staff has ever heard another staff treating residents without dignity and respect.
Based on records reviewed, interviews, and LPA’s observations, the allegations that staff speaks inappropriately to resident and staff threatens resident is UNSUBSTANTIATED, meaning, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

To continue see 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
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 59-AS-20231006120838
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: LARCHMONT MANOR
FACILITY NUMBER: 347004385
VISIT DATE: 05/23/2024
NARRATIVE
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Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies are being cited.

Exit interview held, and a copy of this report was given to Maria.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2