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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001715
Report Date: 08/12/2021
Date Signed: 08/12/2021 04:24:31 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/19/2021 and conducted by Evaluator Michael Bilger
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20210719140534
FACILITY NAME:CARING FAMILIES-BV2FACILITY NUMBER:
347001715
ADMINISTRATOR:MICHELLE MACIASFACILITY TYPE:
740
ADDRESS:8716 BRAY VISTA WAYTELEPHONE:
(916) 686-0420
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 6DATE:
08/12/2021
UNANNOUNCEDTIME BEGAN:
03:18 PM
MET WITH:Michelle MaciasTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
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5
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8
9
Staff handles resident in a rough manner
INVESTIGATION FINDINGS:
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5
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13
On 8/12/21 at 3:18pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver complaint findings for the allegations listed above. LPA met with Administrator Michelle Macias and explained the purpose of this visit. During the course of this investigation, LPA reviewed facility documentation including but not limited to: Physician reports, staffing roster, resident roster, emergency contacts, and incident reports. LPA also conducted interviews with Resident1 (R1), R2, R3, R4, and R5 on the dates 7/28/21 and 8/4/21. Additional interviews were conducted with Staff1 (S1), S2, S3, S4, and S5 on 7-28-21 as well as 3 of 5 responsible persons for residents in care on 8/9/21.
Based on interviews and record reviews, it was determined that there has been no witness to staff rough handling of residents in care, nor residents experiencing rough handling by caregivers. Additional interviews and record review revealed that R5 sustained bruising of unknown origin on 6-1-21, however, there was no reported witness to a fall or rough handling based on these interviews.

{Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
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 2
Control Number 27-AS-20210719140534
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: CARING FAMILIES-BV2
FACILITY NUMBER: 347001715
VISIT DATE: 08/12/2021
NARRATIVE
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Interviews and record reviews also revealed that R5 has a history of frequent movement throughout facility.
Based on interviews conducted and records reviewed, it was determined that the preponderance of evidence standard is not met, therefore the 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 incident occurred.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2