097005554-8-22-2023-59-AS-LMUZ-CV9UJR-20230901153754

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 097005554
Report Date: 08/22/2023
Date Signed: 08/22/2023 02:11:23 PM

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
08/16/2023 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20230816112709

FACILITY NAME:	EL DORADO HILLS SENIOR CARE		FACILITY NUMBER:	097005554
ADMINISTRATOR:	DR. BENJAMIN FOULK		FACILITY TYPE:	740
ADDRESS:	2904 TAM O'SHANTER DRIVE		TELEPHONE:	(916) 933-0107
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	6	CENSUS: 4	DATE:	08/22/2023
		UNANNOUNCED	TIME BEGAN:	02:02 PM
MET WITH:	Administrator Jennifer Hinch		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee did not maintain liability insurance

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Lavinia Muscan and Jaynae Boyles arrived at the facility unannounced on 8/22/23 to open and deliver findings for above allegation. LPAs met with Administartor Jennifer Hinch and explained the purpose of the visit.

Allegation: Licensee did not maintain liability insurance

Based on record reviewed, the department observed facility to have current liability insurance therefore, department finds the allegation to be unfounded - A finding that a complaint allegation is unfounded means that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with Administrator and a copy of this report has been provided to facility.

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: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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 3