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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445294215
Report Date: 12/15/2024
Date Signed: 12/22/2024 09:32:47 AM

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
03/23/2022 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220323122836
FACILITY NAME:SOQUEL LEISURE VILLA, INC.FACILITY NUMBER:
445294215
ADMINISTRATOR:SATO, RENE & HAYDEEFACILITY TYPE:
740
ADDRESS:4101 FAIRWAY DRIVETELEPHONE:
(831) 462-4101
CITY:SOQUELSTATE: CAZIP CODE:
95073
CAPACITY:0CENSUS: DATE:
12/15/2024
UNANNOUNCEDTIME BEGAN:
07:18 PM
MET WITH:TIME COMPLETED:
09:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not providing adequate supervision to resident's.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
The department attempted to contact the facility on multiple phones including the (831) 462-4101. The license issued to this facility address was forfeited pursuant to Health and Safety Code Sections 1524, 1568.061, 1569.19, or 1596.858. The license is no longer valid effective 01/25/2024.

Attempts to contact the former Licensee were not successful. Therefore, the above listed allegation is found to be UNSUBSTANTIATED. UNSUBSTANTIATED complaint findings mean 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.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2024
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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