585002798-9-16-2022-25-AS-LMUZ-CMJ2SR-20221227163935

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 585002798
Report Date: 09/16/2022
Date Signed: 09/16/2022 04:02:25 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/15/2022 and conducted by Evaluator Todd Tryon

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220915143100

FACILITY NAME:	COMFORT HAVEN FOR THE ELDERLY		FACILITY NUMBER:	585002798
ADMINISTRATOR:	JUMAWAN, SUSIE		FACILITY TYPE:	740
ADDRESS:	125 E TENTH STREET		TELEPHONE:	(530) 777-9698
CITY:	MARYSVILLE	STATE: CA	ZIP CODE:	95901
CAPACITY:	48	CENSUS: 39	DATE:	09/16/2022
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Susie Jamawan, Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility staff does not treat resident with respect.
Facility staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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On 9/16/2022 LPA Tryon arrived at the facility to open the complaint. LPA was screened for COVID symptoms upon arrival and termperature taken. LPA wore a mask and used hand sanitizer.
LPA was able to speak with staff and 6 of 39 residents.
Regarding staff treating residents with respect, all residents interviewed felt that staff is very respectful to them and other residents, and no one had issues with staff. Therefore, the allegation is UNFOUNDED.
Regarding safeguarding resident's belongings this allegation was in regard to clothing items being missing. All residents interviewed said they always get their own clothes back when laundry is done. If something is missing, there is a certain place that clothes are kept so that residents can look for their lost items, and almost always can retrieve them. Staff verified that this is the case. Also, if someone has a need for certain items, the home does keep extras if needed. The allegation is UNFOUNDED.
A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.
No deficiencies noted. Exit inteview conducted.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd Tryon	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

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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