075601492-12-29-2022-15-AS-KHOS-CMKPTN-20221229103613

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601492
Report Date: 05/18/2022
Date Signed: 12/29/2022 10:19:02 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2022 and conducted by Evaluator James Sampair

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20220504145129

FACILITY NAME:	JONED'S REST HOME II		FACILITY NUMBER:	075601492
ADMINISTRATOR:	BASBAS, EDGARDO G.		FACILITY TYPE:	740
ADDRESS:	141 VIA MONTE		TELEPHONE:	(925) 323-4463
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	6	CENSUS: 6	DATE:	05/18/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Julieta Basbas		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff stole resident’s money.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) J. Sampair conducted an unannounced complaint visit on 5/10/22 with Licensee Julieta Basbas concerning the above mentioned allegation. During that visit, LPA discovered that records necessary to conduct this investiation are stored off-site. During today's unannounced follow-up visit on 5/18/22, LPA was provided those records and conducted additional interviews of staff.

Based on information gathered, the allegation is UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted with Licensee. A copy of report provided via email.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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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