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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 515000503
Report Date: 05/03/2023
Date Signed: 05/16/2023 02:47:06 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
03/02/2023 and conducted by Evaluator Todd Tryon
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20230302112132

FACILITY NAME:PAUL AND LAURA HASE GUEST HOMEFACILITY NUMBER:
515000503
ADMINISTRATOR:HASE, LAURAFACILITY TYPE:
735
ADDRESS:2429 IVY STREETTELEPHONE:
(530) 695-3905
CITY:LIVE OAKSTATE: CAZIP CODE:
95953
CAPACITY:3CENSUS: 3DATE:
05/03/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Paul and Laura HaseTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff yelled at client
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Regarding the allegation that staff yelled at resident, LPA visited the home, spoke with staff and residents, met with residents at day program and spoke with witnesses. LPA learned that staff has raised her voice on different occasions to make a point to residents. It appears that staff may have spoken loudly or raised their voice to residents on occasion; but LPA cannot say that staff has actually ever “yelled” at residents, as an individual’s interpretation of what comprises “yelling” at someone may vary greatly. Residents state they are not afraid of staff in any way or feel they will be harmed. Residents appear to like the home and the staff and feel like a family. Therefore, LPA is not able to say with certainty that anyone was “Yelled” at. Allegation is Unsubstantiated. A 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.
No deficiencies cited at this visit.
Appeal Rights given.
Exit interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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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