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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803815
Report Date: 07/03/2024
Date Signed: 07/03/2024 04:39:27 PM

Unsubstantiated


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
06/26/2024 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20240626084453
FACILITY NAME:AMERICAN ASSISTED LIVINGFACILITY NUMBER:
486803815
ADMINISTRATOR:SUKHJIT SANDHUFACILITY TYPE:
740
ADDRESS:405 KINGS WAYTELEPHONE:
(510) 604-3825
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY:30CENSUS: 25DATE:
07/03/2024
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Mantu Sandhu, AdministratorTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Staff do not ensure that residents are provided a diet that is of the quality and in the quantity necessary to meet the needs of the resident(s) in care
INVESTIGATION FINDINGS:
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On 7/3/2024, Licensing Program Analysts (LPA's) Tobola and Mutialu arrived unannounced for the purpose of complaint investigation and was greeted by Lead Carestaff, Charity Butler. Administrator, Mantu Sandhu arrived later in the visit. LPA's toured the facility, interviewed staff and residents, reviewed records and made observations during the course of the investigation.

Complaint alleges staff do not ensure that residents are provided a diet that is of the quality and in the quantity necessary to meet the needs of the resident(s) in care. Based upon multiple tours of the facility and LPA observations, there appeared to be a sufficient amount of fresh fruits, vegetables and a general amount of food supplies sufficient in quality and quantity. Resident dietary restrictions are also properly posted in the kitchen area. Due to a lack of corroborating evidence the allegation is found to be unsubstantiated.
A finding that the complaint allegations, Staff do not ensure that residents are provided a diet that is of the quality and in the quantity necessary to meet the needs of the resident(s) in care is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiency cited.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic TobolaTELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
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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