392700899-10-21-2022-27-AS-LKIG-CKEUQB-20221021154651

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700899
Report Date: 10/20/2022
Date Signed: 10/21/2022 03:30:32 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
09/22/2022 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220922142527

FACILITY NAME:	FRUITFUL HUMBLE ABODE		FACILITY NUMBER:	392700899
ADMINISTRATOR:	MABUNGA, JOYCE MAE		FACILITY TYPE:	740
ADDRESS:	1849 COIT STREET		TELEPHONE:	(415) 619-9510
CITY:	MANTECA	STATE: CA	ZIP CODE:	95337
CAPACITY:	6	CENSUS: 4	DATE:	10/20/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Joyce Mabunga		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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9

Unlawful Eviction

INVESTIGATION FINDINGS:

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LPA'S Kesha Lewis and Albert Johnson made an unannounced visit to deliver complaint findings for the allegation listed above. LPA'S interviewed Staff and Clients. As a result of the interviews and facilities visits, LPA'S learned that the resident was able to secure PACE support services and based on this additional help no eviction was made. R1 was never removed from the facility. An eviction letter was given to resident but was not approved by the department. As a result of the PACE support the eviction letter was rescinded.

As a result of this investigation, Investigator finds allegation to be (U) Unfounded - A finding that the complaint is Unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted with Administrator/licensee and a copy of this report was provided to the licensee.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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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