347005407-4-13-2023-27-AS-KHOS-CRGN5F-20230503100927

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005407
Report Date: 04/13/2023
Date Signed: 04/13/2023 03:16:07 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
03/10/2023 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230310114156

FACILITY NAME:	CARING HEART		FACILITY NUMBER:	347005407
ADMINISTRATOR:	ADUCAYEN, GEORGE		FACILITY TYPE:	740
ADDRESS:	9469 MEDSTEAD WAY		TELEPHONE:	(916) 690-5324
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	6	CENSUS: 6	DATE:	04/13/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Serafin Barut - care staff		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff touched resident in an inappropriate manor

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Vincent Moleski and Jason Lund arrived unannounced to deliver findings on this complaint investigation. LPAs Moleski and Lund met with care staff Serafin Barut, who called administrator Kristine Villa. LPAs Moleski and Lund spoke with Villa over the phone and explained the purpose of the visit. Villa gave permission to have Barut sign this report.

This investigation consisted of facility file review, review of personnel and resident records, review of a police report, and an interview with one resident (R1).

During an interview, R1 said he was not touched in an inappropriate manner by staff and he did not believe anything of that nature had occurred.

The department has determined the following as it relates to the allegation that staff touched a resident in an inappropriate manner:

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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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Control Number 27-AS-20230310114156

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: CARING HEART	FACILITY NUMBER: 347005407
	VISIT DATE: 04/13/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based on the interview with R1, staff did not touch the resident inappropriately. Therefore, the above allegation is UNFOUNDED. A finding that the complaint allegation is unfounded means the allegation is false, could not have happened and/or is without a reasonable basis No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was left with Barut.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC9099 (FAS) - (06/04)

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