347005570-12-20-2022-25-AS-LMUZ-CMHQVE-20221227113013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005570
Report Date: 12/20/2022
Date Signed: 12/20/2022 03:08:24 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
11/29/2022 and conducted by Evaluator DeAnna Williams-Lyons

COMPLAINT CONTROL NUMBER: 25-AS-20221129140640

FACILITY NAME:	CLARA CARE HOME		FACILITY NUMBER:	347005570
ADMINISTRATOR:	KIM, JAE YOEL		FACILITY TYPE:	740
ADDRESS:	4665 FREEWAY CIRCLE		TELEPHONE:	(916) 900-4781
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95841
CAPACITY:	6	CENSUS: 5	DATE:	12/20/2022
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Jae Yoel, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Food supply is not adequate to meet the needs of the residents in care.
Facility is too cold for residents in care.

INVESTIGATION FINDINGS:

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On December 20, 2022, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived to deliver findings for complaint #25-AS-2021129140640. LPA met with Jae Yoel, Administrator and informed him the reason for the visit. Prior to initiating the 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 and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and wore a N-95 mask for Personal Protective Equipment.This agency has investigated the complaint alleging Food supply is not adequate to meet the needs of the residents in care and Facility is too cold for residents in care.
LPA interviewed all residents (4) and staff (2) and reviewed documentation pertaining to the investigation. Interviews revealed that all clients get their needs met with no issues or concerns. LPA toured the facility and observed that the facility had the required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. The facility has two refrigerators, and both was full.
To continue see 9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

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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Control Number 25-AS-20221129140640

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: CLARA CARE HOME	FACILITY NUMBER: 347005570
	VISIT DATE: 12/20/2022

NARRATIVE

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The food pantry was checked and there is ample snacks, fruits and vegetables. Interviews have indicated residents have never been denied food at all.

Allegation: Facility is too cold for residents in care. LPA's observed a comfortable temperature in the facility. LPA interviewed 4 residents and 2 staff. LPA conducted a total of 6 interviews. LPA learned that 4 out of 4 residents interviewed indicated the room temperature is fine. LPA learned from 2 staff interviews that the facility maintains a comfortable room temperature throughout the day with no issues.

Based upon LPA's observations, interviews conducted with residents, staff and review of pertinent documents received, there is not substantial evidence to support or disprove that the alleged violations occurred. Due to the preponderance of evidence standard not being met by the department standard. There is no physical evidence to support the validity of the allegations as well as witness statements. LPA has deemed the complaint findings as UNSUBSTANTIATED. Although the allegations may have happened and/or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

Exit interview conducted with Administrator Jae. A copy of this report was given.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

LIC9099 (FAS) - (06/04)

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