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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 12:17:48 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
04/30/2020 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20200430144919
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:
12:00 PM
MET WITH:Analiza Wright, Administrator
Jane Rotich, Caregiver
TIME COMPLETED:
12:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Item missing after return of resident personal belongings
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/16/22 at 12PM, 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 on the phone who authorized staff (S1) to act on her behalf and sign the report.

Allegation: Item missing after return of resident personal belongings
Investigation Finding: UNSUBSTANTIATED
Per interviews (and record reviews), investigation determined that family did not contact the facility to make inquiry into the subject item (a ring). Facility staff stated that the ring was removed from R1 due to a swelling condition to his hands and fingers. Staff placed R1’s ring in a secured cabinet and overlooked it when R1s personal items were packed for return - which could not be disproven. During investigation, the item was retrieved by staff and returned to the family.

Based upon records review, interviews and observations, the department has investigated the above allegation and found that it is unsubstantiated. A finding that the complaint is 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 violation occurred. 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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