415600900-9-22-2020-14-AS-JMOS-BTWUCL-20200929152807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600900
Report Date: 09/22/2020
Date Signed: 09/22/2020 01:11:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/18/2020 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20200918091655

FACILITY NAME:	ABIGAIL COMPLETE CARE, INC		FACILITY NUMBER:	415600900
ADMINISTRATOR:	FRAGIACOMO, VIVIAN		FACILITY TYPE:	740
ADDRESS:	1230 HOPKINS AVENUE		TELEPHONE:	(650) 224-8853
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94062
CAPACITY:	24	CENSUS: 23	DATE:	09/22/2020
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Vivian Fragiacomo		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff would not allow resident's to have remote visits with hospice

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On September 22, 2020 at 1130 Licensing Prgram Analyst (LPA) Jaime Vado conducted an unannounced complaint tele-inspection regarding the allegation recieved. LPA spoke to the administrator Vivian Fragiacomo.

During todays tele-inspection LPA interviewed, and discussed, the allegation and it's details with Vivian. According to Vivian the resident (R1) resides at another facility and never received care at this facility. Due to the discovery of this information this allegation does not pertain or hold merit in regards to the care received at this facility.

Based on the information obtained, the above allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. Report is discussed with licensee about the process in which the facility will receive a copy of this report and the e-signing of this document. A copy of this report is sent to adminsitrator Vivian Fragiacomo at 1315hrs on September 22, 2020.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020

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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