097000177-7-3-2024-59-AS-LMUZ-D74M6N-20240712092012

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 097000177
Report Date: 07/03/2024
Date Signed: 07/03/2024 11:50:26 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, 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
02/07/2024 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20240207154557

FACILITY NAME:	LARC'S CARE HOME		FACILITY NUMBER:	097000177
ADMINISTRATOR:	SUSBILLA, CORAZON R.		FACILITY TYPE:	740
ADDRESS:	3488 LA CANADA DRIVE		TELEPHONE:	(530) 677-6724
CITY:	CAMERON PARK	STATE: CA	ZIP CODE:	95682
CAPACITY:	6	CENSUS: 4	DATE:	07/03/2024
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Administrator Corazon Susbilla		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Staff are financially abusing resident in care

INVESTIGATION FINDINGS:

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On 7/3/24, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Corazon Susbilla.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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 59-AS-20240207154557

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LARC'S CARE HOME	FACILITY NUMBER: 097000177
	VISIT DATE: 07/03/2024

NARRATIVE

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Staff are financially abusing resident in care
Throughout the course of the investigation the department conducted interviews and reviewed documentation relevant to the allegation: Staff are financially abusing resident in care. The department reviewed resident documentation, licensee documentation, and bank records. The department reviewed R1’s bank statements and observed multiple withdrawals each month for much of their stay at the facility. Interviews with licensee indicated they did not manage resident money or keep track of R1 spending. Interview conducted with resident (R1) revealed that no financial abuse occurred and/or that financial maleficence has occurred therefore the allegation above is UNFOUNDED. This agency has investigated this complaint. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted and copy of report provided to licensee.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

LIC9099 (FAS) - (06/04)

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