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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601562
Report Date: 03/16/2022
Date Signed: 03/16/2022 12:01:40 PM

Unsubstantiated


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
04/14/2020 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20200414112337
FACILITY NAME:CORTE VISTA GUEST HOMEFACILITY NUMBER:
075601562
ADMINISTRATOR:BRYSON WRIGHTFACILITY TYPE:
740
ADDRESS:1724 CORTE VISTA STREETTELEPHONE:
(925) 586-6598
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:6CENSUS: 5DATE:
03/16/2022
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Analiza Wright, Administrator
Jane Rotich, Caregiver		TIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to issue proper refund
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/16/22 at 11:15AM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced subsequent complaint visit with administrator to deliver the finding of above allegation. LPA explained the purpose of the visit with administrator (ADM) on the phone who authorized staff (S1) to act on her behalf and sign the reports.

Allegation: Facility failed to issue proper refund
Investigation Finding: UNSUBSTANTIATED
During investigation, reporting party (RP) called Licensing Program Analyst (LPA1) back on 04/20/2020 at 3:30PM and stated that she received the facility refund check of $2700 by hand delivery from local ombudsman on 04/14/2020. Local ombudsman called the facility, picked up the refund check as well as R1's belongings, then delivered them personally to RP on 04/14/2020.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. No deficiencies cited. Exit Interview conducted and a copy of this report provided via email.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022
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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