502700869-4-3-2024-27-AS-LRIS-D46P4J-20240409105914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700869
Report Date: 04/03/2024
Date Signed: 04/03/2024 02:30:11 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/12/2023 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20231212084116

FACILITY NAME:	ORANGEBURG MANOR		FACILITY NUMBER:	502700869
ADMINISTRATOR:	ARBIOS, MARIE		FACILITY TYPE:	740
ADDRESS:	1248 NELSON AVENUE		TELEPHONE:	(209) 527-2222
CITY:	MODESTO	STATE: CA	ZIP CODE:	95350
CAPACITY:	90	CENSUS: 39	DATE:	04/03/2024
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Executive Director Jennifer Whiteley		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Licensee does not ensure the facility is in good repair at all times

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegation. LPA Lund met with Executive Director Jennifer Whiteley and explained the reason for the visit. Census:39

Licensee does not ensure the facility is in good repair at all times - LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on records review the facility had repairs done to the kitchen on 11/30/2023, 12/11/2023, 12/21/2023, 1/4/2024, 2/6/2024 & 3/9/2024. Staff interviewed stated that it didn’t affect the residents’ meals. Residents interviewed stated that they were not affected bye the kitchen repairs that meals were on time and sufficient.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

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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Control Number 27-AS-20231212084116

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ORANGEBURG MANOR	FACILITY NUMBER: 502700869
	VISIT DATE: 04/03/2024

NARRATIVE

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Based on reviewed facility records, interviewed staff, and residents in care on the information provided, it was unclear if licensee does not ensure the facility is in good repair at all times, therefore the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and report left.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

LIC9099 (FAS) - (06/04)

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