502700543-8-5-2022-27-AS-KHOS-CHLLPC-20220824085543

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700543
Report Date: 08/04/2022
Date Signed: 08/05/2022 09:50:50 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/14/2022 and conducted by Evaluator Arielle Pascua

COMPLAINT CONTROL NUMBER: 27-AS-20220614125434

FACILITY NAME:	AG ADULT RESIDENTIAL CARE HOME		FACILITY NUMBER:	502700543
ADMINISTRATOR:	NKWOCHA, ONYEMA		FACILITY TYPE:	735
ADDRESS:	3829 WILD PALMS DR		TELEPHONE:	(209) 275-3272
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY:	4	CENSUS: 4	DATE:	08/04/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Sheriff Kabba		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Residents are not treated equally

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Arielle Pascua conducted an unannounced facility visit on 08/04/2022 to deliver complaint findings. LPA Pascua was greeted by caregiver, Sheriff Kabba and was told to contact the Administrator to let them know that CCL was present at this time. Shortly after, LPA Pascua met with Facility Designated Administrator, Oynema Nkwocha and explained the purpose of the visit.
Current census is 4. Throughout the course of this investigation, LPA Pascua conducted interviews and reviewed facility documents. Based on interviewed conducted, residents and staff members denied being treated differently from other residents. An interview with the Facility Designated Administrator was conducted and confirmed that he tries to train staff to treat all residents with respect. He also stated that he does not know of any issues between staff members and residents.
As a result of this investigation, the Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.
No deficiencies cited per Title 22 Regulations. Exit interview was conducted and a copy of this report was given to the Facility Designated Administrator, Oynema Nkwocha.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

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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