392700402-5-18-2023-27-AS-LKIG-CSBLHW-20230530084700

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700402
Report Date: 05/17/2023
Date Signed: 05/18/2023 05:00:05 PM

Unsubstantiated

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
01/24/2023 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230124082144

FACILITY NAME:	WELDWOODS		FACILITY NUMBER:	392700402
ADMINISTRATOR:	ETIM, BOKIME		FACILITY TYPE:	735
ADDRESS:	1490 PELUSA LN		TELEPHONE:	(510) 470-2881
CITY:	MANTECA	STATE: CA	ZIP CODE:	95337
CAPACITY:	6	CENSUS: 4	DATE:	05/17/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ngozi Etim		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff does not provide residents access to food.

Staff does not provide residents food options.

Facility did not adhere to Admission's Agreement.

INVESTIGATION FINDINGS:

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Unannounced complaint visit made out to this facility on 05/17/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility representative, Ngozi Etim, who was requested by this LPA to go ahead and contact the facility designated Administrator to let him know that CCL was present at this time. It was learned that the facility designated Administrator was at an appointment with a facility resident at this time and was unable to be present.
Brief interview was conducted with the facility representative at this time. Also present was another facility staff member, Ude Etim, at this time.
Current census was 4 residents, of which 3 residents, were out of this facility at their respective day programs at this time. One resident was at an appointment with the facility designated Administrator.
The purpose of this visit was to deliver the findings of this investigation unto this facility and its representative at this time.
Based on interviews and information gathered during the course of this investigation, it was learned that this facility has a variety of perishable and non perishable food items that are prepared and offered to the facility

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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-20230124082144

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: WELDWOODS	FACILITY NUMBER: 392700402
	VISIT DATE: 05/17/2023

NARRATIVE

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residents on a daily basis. Food items varied for breakfast, lunch, and dinner meals. In addition, there was a variety of food snacks as well that were made available to the residents at this time.
It was learned that sanitation and cleanliness was highly maintained and facility residents are not prohibited from gaining access to the food items but are expected to wash their hands to prevent contamination. It was learned that there were issues of contamination and cleanliness due to resident behaviors and personalities so facility personnel closely watched the food storage units to make sure that they were clean and maintained in compliance at all times. This was done in order to prevent any outbreaks due to poor food storage, preparation, and overall consumption of any food items at this time.
It was learned that this facility was vendorized to accept and retain Level 4I residents at any given time.
Based on a review of the facility forms and documents related to the facility residents, specifically for R1, it was learned that excessive behaviors, property destruction, and substance abuse were ongoing for this particular resident. A review of the Individual Program Plan (IPP), completed and dated on 08/19/2022 for R1, indicated that R1 was dealing with housing issues and meeting individual goals. It was observed that facility personnel were always maintained to make sure that proper care and supervision was maintained in compliance at this time.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred.

There were no deficiencies observed or cited during today's complaint visit.

Exit Interview

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC9099 (FAS) - (06/04)

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