486803228-5-11-2023-21-AS-CMAZ-CRWUPF-20230517154526

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803228
Report Date: 05/11/2023
Date Signed: 05/11/2023 03:38:02 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/02/2023 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 21-AS-20230502161753

FACILITY NAME:	CRESTWOOD HOPE CENTER		FACILITY NUMBER:	486803228
ADMINISTRATOR:	WALLER, VINCENT		FACILITY TYPE:	740
ADDRESS:	115 ODDSTAD DRIVE		TELEPHONE:	(707) 552-0215
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94589
CAPACITY:	24	CENSUS: 22	DATE:	05/11/2023
		UNANNOUNCED	TIME BEGAN:	02:01 PM
MET WITH:	Danvie Cardano, Service Coordinator		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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9

Personal Rights

INVESTIGATION FINDINGS:

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On 5/11/2023 LPA Tobola conducted a facility visit for the purpose of initiating complaint investigation. LPA arrived and was greeted by Service Coordinator, Danvie Cardano. LPA conducted interviews with staff and reviewed facility documentation.

Based on interviews with Service Coordinator and Staff (S1) and a review of resident census reports LPA found that resident (R1) does not currently reside in the RCFE licensed facility. In addition, upon resident census review R1 had not resided in the RCFE licensed facility in March or April of 2023 prior to the reporting date, therefore the allegations did not occur in the CCLD licensed RCFE facility and are determined to be UNFOUNDED.

This agency has investigated the complaint allegation listed above. We have found that the complaint allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies cited during the visit.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

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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