502701194-9-12-2024-27-AS-LRIS-D9GQ2Q-20240926114730

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502701194
Report Date: 09/12/2024
Date Signed: 09/12/2024 03:32:11 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
06/17/2024 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20240617162927

FACILITY NAME:	HOSPITALITY HOUSE		FACILITY NUMBER:	502701194
ADMINISTRATOR:	PADILLA, LORRAINE		FACILITY TYPE:	740
ADDRESS:	5400 KIERNAN AVENUE		TELEPHONE:	(209) 543-9275
CITY:	SALIDA	STATE: CA	ZIP CODE:	95368
CAPACITY:	80	CENSUS: 42	DATE:	09/12/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Administrator Lorraine Padilla		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Unlawful eviction

Staff did not prevent resident from getting into a physical confrontation with another resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund met with Administrator Lorraine Padilla and explained the reason for the visit. Census: 42

Unlawful eviction- Based on records reviewed and interviews conducted with Administrator Lorraine Padilla, and Reporting Party (RP). The facility sent LPA Lund a copy of the 30- day notice on 6/4/2024 and it was reviewed and approved. On 6/4/2024 Resident (R1) was given a 30- day notice. On 6/18/2024 LPA Lund spoke with Resident R1 at the facility and told R1 that 30- day notice meet the requirements and was given properly. On July 3, 2024, R1 moved to another facility.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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-20240617162927

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: HOSPITALITY HOUSE	FACILITY NUMBER: 502701194
	VISIT DATE: 09/12/2024

NARRATIVE

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Based on records reviewed and interviews conducted with Administrator Lorraine Padilla, and Reporting Party (RP). the information provided, it was unclear if unlawful eviction therefore the allegation was deemed UNSUBSTANTIATED.

Staff did not prevent resident from getting into a physical confrontation with another resident- Based on records reviewed and interviews with staff, residents and Reporting Party. According to LIC624 Unusual Incident/Injury Report Resident (R1) and Resident (R2) got into physical confrontation during lunch on 3/21/2024. Staff separated them, no injuries were reported from R1 or R2. After the incident the facility moved R2 to another room to create separation from R1. Administrator Lorraine Padilla directed staff to redirect R1 and R2 to try to keep each other separated.

Based on records reviewed and interviews with staff, residents and Reporting Party the information provided, it was unclear if staff did not prevent resident from getting into a physical confrontation with another resident 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, 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: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC9099 (FAS) - (06/04)

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