585002798-5-5-2023-25-AS-LMUZ-CRNRG6-20230509130014

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 585002798
Report Date: 05/05/2023
Date Signed: 05/05/2023 10:00:12 AM

Unfounded

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
02/14/2023 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20230214132839

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: 38	DATE:	05/05/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Maria Medrano		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility staff do not treat resident with respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melissa Parks arrived at the facility unannounced to deliver complaint findings into the allegation listed above and met with Administrator Maria.

Department interviewed 3 staff and 3 residents during complaint investigation on 04/24/23. Department conducted the investigation for the stated allegation from this complaint. Department conducted a tour of the facility on 04/24/23 and conducted interviews with residents and staff. Interviews indicated that all staff are treating all residents with dignity and respect. Department observed while doing facility tour on 04/24/23 that facility staff appeared to be attentive to resident’s needs and treating residents with dignity and respect. During residents’ interviews, residents stated that facility staff is treating all residents with respect and dignity and did not express any concern in this area. Based on facility tour, interviews and observation, department found out that there is no evidence that facility staff do not treat resident with respect, therefore this allegation is found to be UNFOUNDED. Exit interview conducted. A copy of this report was emailed to the Administrator.

Unfounded

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

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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