361800095-7-29-2020-18-AS-EMAN-BSUUXK-20200826155826

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800095
Report Date: 07/29/2020
Date Signed: 07/29/2020 10:56:22 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/11/2020 and conducted by Evaluator Natalie Gayoso

COMPLAINT CONTROL NUMBER: 18-AS-20200611113100

FACILITY NAME:	GRACIOUS LIVING		FACILITY NUMBER:	361800095
ADMINISTRATOR:	KRAUSE, DAVID		FACILITY TYPE:	740
ADDRESS:	312 W ASTER		TELEPHONE:	(909) 816-7697
CITY:	UPLAND	STATE: CA	ZIP CODE:	91786
CAPACITY:	6	CENSUS: 3	DATE:	07/29/2020
		UNANNOUNCED	TIME BEGAN:	10:28 AM
MET WITH:	Paul Krause - Administrator		TIME COMPLETED:	10:41 AM

ALLEGATION(S):

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Staff spoke inappropriately to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natalie Gayoso contacted the facility via telephone due to COVID-19 to conclude investigation and deliver findings. LPA identified herself and discussed the purpose of the call and the elements of the allegation with Administrator Paul Krause.

The investigation consisted of file review and interviews with relevant parties. The allegation indicates staff spoke inappropriately to resident. Interviews with Residents #1 thru #3, indicated that they are happy living at the facility and have never heard or been spoken to inappropriately by staff. Residents stated staff treat them very well and assist them immediately when needed. Interviews with staff #2-#4, denied ever speaking inappropriately to residents. Staff stated they have never yelled or been rude when speaking to residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie Gayoso	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2020

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 18-AS-20200611113100

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: GRACIOUS LIVING	FACILITY NUMBER: 361800095
	VISIT DATE: 07/29/2020

NARRATIVE

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Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies were cited during this visit. An exit interview was conducted with the administrator via telephone and a copy of this report was provided to the administrator via email. Report with facility signature was obtained.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie Gayoso	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2020

LIC9099 (FAS) - (06/04)

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