405802300-4-28-2022-29-AS-KBUY-CE6SWX-20220506141503

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405802300
Report Date: 04/28/2022
Date Signed: 04/28/2022 12:13:34 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2022 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20220426121302

FACILITY NAME:	HOPE ASSISTED LIVING		FACILITY NUMBER:	405802300
ADMINISTRATOR:	CASTANIAGA, JANELYN		FACILITY TYPE:	740
ADDRESS:	1023 SLEEPY HOLLOW		TELEPHONE:	(805) 717-4578
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	6	CENSUS: 6	DATE:	04/28/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Janelyn Castaniaga, Administrator		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Facility is dirty.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted an unannounced 10-day complaint investigation visit to the facility above. LPA met with Janelyn Castaniaga, Administrator, and explained the purpose of the visit. LPA toured the facility at 10:20am.

On the Allegation: Facility is dirty. A credible witness (W1) stated on 4/25/2022, the kitchen apeared dirty. On 4/28/22 LPA observed resident rooms were clean. LPA observed the range hood to be full of dirt, dust bunnies, and grease; observed cobwebs above the kitchen cupboards up to the ceiling; kitchen cupboards and kitchen refrigerator had spilled food in them. LPA also observed the kitchen floor was dirty. Based on the evidence this allegation is deemed Substantiated at this time.

Exit interview, deficiency cited on 9099-D, report emailed, appeal rights given.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 29-AS-20220426121302

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HOPE ASSISTED LIVING	FACILITY NUMBER: 405802300
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/28/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/02/2022 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to clean and disinfect the entire area and provide a video or photos of the cleaned facility to CCL by 5/2/22.
	8 9 10 11 12 13 14	Based on Observations the licensee did not comply with the above, Facility was not clean, or sanitary which poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2022 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20220426121302

FACILITY NAME:	HOPE ASSISTED LIVING		FACILITY NUMBER:	405802300
ADMINISTRATOR:	CASTANIAGA, JANELYN		FACILITY TYPE:	740
ADDRESS:	1023 SLEEPY HOLLOW		TELEPHONE:	(805) 717-4578
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	6	CENSUS: 6	DATE:	04/28/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Janelyn Castaniaga, Administrator		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Food services are inadequate.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted an unannounced 10-day complaint investigation visit to the facility above. LPA met with Janelyn Castaniaga, Administrator, and explained the purpose of the visit. LPA toured the facility.

On the allegation: Food services are inadequate. LPA interviewed staff and residents, reviewed food receipts, obtained photographic evidence, and observed the facility’s food supply during a walkthrough. LPA observed adequate food to meet the needs of the residents. A credible witness (W1) stated on 4/25/2022, W1 observed limited food on hand, only fresh apples and a stalk of celery, and there was no canned fruit. On 4/28/2022 at 10:20am, LPA observed frozen and fresh peas, lettice, carrots, oranges, apples, canned fruit and vegetables enough for 6 residents.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20220426121302

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HOPE ASSISTED LIVING	FACILITY NUMBER: 405802300
	VISIT DATE: 04/28/2022

NARRATIVE

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The administrator showed LPA their phone with pictures that are date and timestamped. The photos are from 4/25/2022 at 8:56am, and show at least 24 cans of fruit, and several large cans of vegetables. The receipt the administrator provided is dated 4/25/2022 at 6:47pm and indicates oranges, bananas, apples, watermelon, cabbage, carrots, and apples were purchased.
Based on the information obtained, the supply of food was of the quality and variety to meet the dietary needs of the residents daily. Therefore the allegation is deemed unsubstantiated at this time.

Exit interview, report emailed.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

LIC9099 (FAS) - (06/04)

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