405809547-11-17-2022-29-AS-KBUY-CLFSMB-20221123125939

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405809547
Report Date: 11/17/2022
Date Signed: 11/17/2022 04:59:00 PM

Unsubstantiated

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
11/04/2022 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20221104165038

FACILITY NAME:	OAKS AT NIPOMO, THE		FACILITY NUMBER:	405809547
ADMINISTRATOR:	TRACY S. FLAHERTY		FACILITY TYPE:	740
ADDRESS:	177 MARY AVENUE		TELEPHONE:	(805) 723-5206
CITY:	NIPOMO	STATE: CA	ZIP CODE:	93444
CAPACITY:	122	CENSUS: 101	DATE:	11/17/2022
		UNANNOUNCED	TIME BEGAN:	04:20 PM
MET WITH:	Tracy Flaherty, Administrator		TIME COMPLETED:	05:05 PM

ALLEGATION(S):

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Facility kitchen is not kept clean or sanitary
Food is not being handled, prepared or stored appropriately
Contaminated food is being served to residents and staff

INVESTIGATION FINDINGS:

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Licensing program Analyst (LPA) De Leon conducted a subsequent complaint visit to the facility above to deliver final findings. LPA met with Administrator Tracy Flaherty and explained the purpose of the visit.

LPA conducted the initial complaint visit on 11/10/2022, collected documents, interviewed staff and toured the kitchen. LPA interviewed staff on 11/07/2022 at 4:34pm, 5:29pm, 6:29pm, 6:51pm, 7:15pm, 11/10/2022 at 2:20pm, 2:35pm, 3:10pm, 3:30pm, and 4:40pm and 11/17/2022 at 12:05pm, 12:29pm. LPA interviewed Residents on 11/04/2022 at 1:41pm, 1:47pm, 1:54pm, 4:30pm, on 11/07/2022 at 4:02pm. LPA interviewed witnesses on 11/04/2022 at 4:50pm, on 11/07/2022 at 2:44pm, 3:48pm, and 3:29pm.

Continued 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

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 29-AS-20221104165038

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: OAKS AT NIPOMO, THE	FACILITY NUMBER: 405809547
	VISIT DATE: 11/17/2022

NARRATIVE

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On the allegation: Facility kitchen is not kept clean or sanitary. Based on interviews the kitchen is kept clean and sanitary. The kitchen is cleaned daily. The stations are sanitized daily. LPA toured the facility kitchen on 11/10/2022 it was clean and sanitary with no odors, no rotten food and the floors were clean and not sticky. Based on the lack of evidence this allegation is deemed Unsubstantiated at this time.

On the allegation: Food is not being handled, prepared or stored appropriately. Based on interviews the food is handled, prepared and stored appropriately, kitchen equipment is working and proper for the facility, food is stored, labeled and any spoiled food is thrown out immediately. Based on the lack of evidence this allegation is deemed Unsubstantiated at this time.

On the allegation: Contaminated food is being served to residents and staff. Based on interviews food produce goes back quickly after delivery and is immediately discarded when it goes bad or starts to mold. Fresh fruit has been delivered already moldy and thrown away immediately. No food is ever served contaminated to anyone. Based on the lack of evidence this allegation is deemed Unsubstantiated at this time.

Exit interviewed conducted and copy of report emailed to Administrator

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC9099 (FAS) - (06/04)

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