435202705-2-17-2024-26-AS-KHOS-D36L9E-20240308073326

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202705
Report Date: 02/16/2024
Date Signed: 02/17/2024 05:47:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/16/2021 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20210816135004

FACILITY NAME:	CRESCENT OAKS		FACILITY NUMBER:	435202705
ADMINISTRATOR:	SANDOVAL, GRACE		FACILITY TYPE:	740
ADDRESS:	147 CRESCENT AVE		TELEPHONE:	(408) 730-4004
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY:	44	CENSUS: 28	DATE:	02/16/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Ollie Vance		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Insufficient staffing to meet resident needs

INVESTIGATION FINDINGS:

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On 2/16/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegation. LPA met with Administrator Ollie Vance. LPA explained the purpose of the visit.

Regarding the allegation of insufficient staffing to meet residents’ needs. Reporting party (RP) called about staffing shortage. RP also mentioned that the temporary staff from the agency were sometimes nowhere to be found.

LPA Ng conducted interviews with different staff members. Three out of seven staff members interviewed stated that there are occasions where there is insufficient staffing. One staff member, S1, mentioned that usually there were agency staff on duty to help the regulars. But sometimes the agency staff came one to two hours late. Sometimes not showing up at all. There were times that the caregivers could not finish the tasks on time. Another staff member, S2, stated that the management tried to get the agency staff, but no agency staff came though. It was shorthanded. But the truth is that it did not happen a lot. Usually there were four caregivers in each shift. The other four staff members stated that there is not insufficient staffing in the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

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 26-AS-20210816135004

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: CRESCENT OAKS	FACILITY NUMBER: 435202705
	VISIT DATE: 02/16/2024

NARRATIVE

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According to the previous Administrator, he/she admitted that some staff called in and did not show up to work the past weekend (August 14 & 21, 2021). The facility had contracts with other agency staff to fill up the position if staff calls in. However, the administrator did not state which day of the weekend someone called out.

Based on record reviews, on the date of August 15, 2021, for the morning shift there were two regular staff and three agency staff scheduled. Aside from this, there is also a Med Tech scheduled. For the afternoon shift, there are three regular staff and one agency staff.

Based on interviews and record reviews, the department has determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

The report was reviewed, and a copy is provided.

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

LIC9099 (FAS) - (06/04)

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