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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507001829
Report Date: 04/02/2024
Date Signed: 04/02/2024 10:32:13 AM

Substantiated


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
12/18/2023 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20231218133219
FACILITY NAME:KANNO'S COMFORT CAREFACILITY NUMBER:
507001829
ADMINISTRATOR:JANET KANNOFACILITY TYPE:
735
ADDRESS:3602 E ORANGEBURG AVENUETELEPHONE:
(209) 526-8934
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:6CENSUS: 6DATE:
04/02/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Saul KannoTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility stove is in disrepair.
INVESTIGATION FINDINGS:
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On 04/02/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct a complaint visit. LPA met with Facility Designated Representative (FDR), Saul Kanno and explained the purpose of the visit.

Current census was 6. 6 out 6 residents were out at their respective day program. A brief interview was conducted with FDR Kanno.

The purpose of the visit was to delivery complaint findings for the allegation above.

It was alleged that the facility stove is in disrepair. Based on interviews conducted it was learned that the facility stove had a broken bake element and had a inoperable heating coil on the oven. The facility administrator was not notified from staff that the facility stove was not working properly therefore was not aware that the facility did not have an operable stove at this time.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 27-AS-20231218133219
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: KANNO'S COMFORT CARE
FACILITY NUMBER: 507001829
VISIT DATE: 04/02/2024
NARRATIVE
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LPA Pascua was notified that part was ordered however, the facility decided to purchase a new stove. LPA Pascua reviewed a receipt from American Freight which confirmed a purchase of a new stove. Based on the information provided the facility’s stove was in disrepair.

Based on observations, review of records and information gathered through interviews, the above allegations were SUBSTANIATED meaning that there was a preponderance of evidence to prove that the allegations occurred as alleged.

An exit interview was conducted, a copy of the LIC9099, LIC9099-C, 9099-D, and appeals rights was provided to the Facility.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20231218133219
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: KANNO'S COMFORT CARE
FACILITY NUMBER: 507001829
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/02/2024
Section Cited
CCR
80087(a)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
This is not met as evidenced by:
The licensee did not ensure that the facility stove was in disrepair.
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Licensee has bought a brand new stove. LPA cleared this POC on 04/02/2024.
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Based on observation and interview, it was found that the facility stove did not have a working heating coil.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
12/18/2023 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20231218133219

FACILITY NAME:KANNO'S COMFORT CAREFACILITY NUMBER:
507001829
ADMINISTRATOR:JANET KANNOFACILITY TYPE:
735
ADDRESS:3602 E ORANGEBURG AVENUETELEPHONE:
(209) 526-8934
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:6CENSUS: 6DATE:
04/02/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Saul KannoTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff do not provide a comfortable temperature for residents.
Staff does not ensure resident's furniture is free of mold.
Staff do not allow resident's to have access to dryer.
INVESTIGATION FINDINGS:
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On 04/02/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct a complaint visit. LPA met with Facility Designated Representative (FDR), Saul Kanno and explained the purpose of the visit. The purpose of the visit was to delivery complaint findings for the allegations above.

Staff do not provide a comfortable temperature for residents.
It was alleged that the staff do not provide a comfortable temperature for residents. During the course of this investigation, LPA conducted 4 resident interviews. 4 out 4 residents state that they believe that the temperature in the facility is comfortable and are not too hot or too cold. 4 out 4 residents state that they are able to tell the administrator or staff that they are too hot or too cold so that they can change the temperature. . LPA Pascua observed a thermostat at a temperature of 70 degrees in working condition and was able to turn on and turn off the component with no issues noted. Based on the information gathered it is unclear that the staff do not provide a comfortable temperature for residents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20231218133219
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: KANNO'S COMFORT CARE
FACILITY NUMBER: 507001829
VISIT DATE: 04/02/2024
NARRATIVE
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Staff does not ensure resident’s furniture is free of mold.

It was alleged that the staff does not ensure resident’s furniture is free of mold. During the course of this investigation LPA toured the facility and conducted interviews. Based on interviews conducted it was learned that there was a stain in a residents bed that was part of the wood when the bed set was assembled. LPA toured the resident bedrooms and the LPA did not find any signs of mold in any bedrooms at this time. LPA toured R1’s bedroom where it was alleged that the resident’s furniture had mold. LPA observed several wood stains and dots that did not appear to be mold. It was denied by staff that the resident’s rooms have been treated with mold. LPA conducted an interview with 4 residents. 4 out of 4 residents state that there rooms have been clean and free of mold. Based on the information gathered it is unclear that the staff does not ensure resident’s furniture is free of mold.

Staff do not allow resident's to have access to dryer.

It was alleged that the staff do not allow resident’s to have access to the dryer. During the course of this investigation LPA conducted interviews. 4 out of 4 residents stated that they have access to do their own laundry at any time with assistance from the staff. 4 out 4 residents state that in the summer they like to dry their clothes on a clothes line outside. 4 out 4 residents states that they have the option to do their own laundry. 3 out 3 staff deny that they do not allow resident’s to have access to the dryer. It was also disclosed that most laundry is conducted when the resident’s are out at their respective day programs. Based on the information gathered, it is unclear that the staff do not allow residents to have access to the dryer.

As a result of this investigation, this 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.



There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5