502701055-8-1-2023-27-AS-SRIN-CUQMG9-20230815093536

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502701055
Report Date: 08/01/2023
Date Signed: 08/01/2023 03:26:15 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, 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
03/22/2023 and conducted by Evaluator Jason Lund

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230322144051

FACILITY NAME:	ASPEN VILLE CO		FACILITY NUMBER:	502701055
ADMINISTRATOR:	BHATIA, JASRAJ		FACILITY TYPE:	740
ADDRESS:	5412 KIERNAN AVENUE		TELEPHONE:	(669) 265-4603
CITY:	SALIDA	STATE: CA	ZIP CODE:	95368
CAPACITY:	32	CENSUS: 28	DATE:	08/01/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator Jasraj Bhatia		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility does not ensure that staff have the ability to communicate with residents in care
Staff did not ensure transportation arrangements were made for resident in care
Staff did not ensure resident's room is free of insects

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA met with Administrator Jasraj Bhatia and explained the reason for today’s visit. Census 28

Facility does not ensure that staff have the ability to communicate with residents in care- Based on interviews with staff, residents in care, RP, and LPA Lund’s observation. Staff (S1) is able to communicate with residents in care either through talking one on one with resident or through a staff member. The staff member only does transportation. Residents interviewed stated they have not missed any appointments because of S1.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

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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Control Number 27-AS-20230322144051

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ASPEN VILLE CO	FACILITY NUMBER: 502701055
	VISIT DATE: 08/01/2023

NARRATIVE

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Based on interviews with staff, residents, RP and LPA Lund’s observation the information provided, it was unclear if facility does not ensure that staff have the ability to communicate with residents in care therefore the allegation was deemed UNSUBSTANTIATED.

Staff did not ensure transportation arrangements were made for resident in care- Based on records reviewed and interviews with staff, residents in care and RP. Resident (R1) stated that R1 made own doctors’ appointments and the facility would take R1 to appointments. R1 stated “That R1 missed an appointment because the facility didn’t have anyone to take R1 to the appointment. R1 was not sure when R1 told the facility about the appointment if R1 gave enough advance notice.” Facility policy would like 48 hours advance notice to make arrangements for resident’s appointments. Residents interviewed stated “That they have not missed any appointments while at the facility.”

Based on facility records review, interviews with staff, residents and RP information provided, it was unclear if staff did not ensure transportation arrangements were made for resident in care therefore the allegation was deemed UNSUBSTANTIATED.

Staff did not ensure resident's room is free of insects- Based on records reviewed and interviews with staff residents, RP and LPA Lund’s observation. LPA Lund reviewed three months on pest control reports and no pests during LPA’s visits at the facility. Staff and residents interviewed stated that they have not noticed a pest control problem at the facility.

Based on facility records review, interviews with staff, clients, RP and LPA’s observation the information provided, it was unclear if staff did not ensure resident's room is free of insects therefore the allegation was deemed UNSUBSTANTIATED.

The Department (CCLD) has found the allegations. Unsubstantiated.
A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.
An exit interview was conducted with Administrator Jasraj Bhatia and report left.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

LIC9099 (FAS) - (06/04)

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