455002636-4-12-2023-59-AS-KHOS-CSCSBX-20230531134440

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002636
Report Date: 04/12/2023
Date Signed: 04/12/2023 04:06:36 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/24/2023 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 59-AS-20230324121124

FACILITY NAME:	NEW VISION SERVICES SENIOR LIVING		FACILITY NUMBER:	455002636
ADMINISTRATOR:	WILLIAMS, KENNETH		FACILITY TYPE:	740
ADDRESS:	1850 LAKE BLVD		TELEPHONE:	(916) 224-2206
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	24	CENSUS: 18	DATE:	04/12/2023
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Evelyn Williams		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility evicted resident improperly

INVESTIGATION FINDINGS:

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LPA Hiratsuka, conducted this visit to deliver the results of the investigation above.

LPA Hiratsuka investigated the allegation “Facility evicted resident improperly.” LPA interviewed staff and the responsible party for the resident. LPA confirmed the resident was at this facility for a respite stay.

“This agency has investigated the complaint alleging; Facility evicted resident improperly. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis."

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

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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