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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 097001794
Report Date: 09/08/2022
Date Signed: 09/08/2022 11:17:20 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2022 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 25-AS-20220722104104
FACILITY NAME:OAK HILL SENIOR CAREFACILITY NUMBER:
097001794
ADMINISTRATOR:OMITA KHANFACILITY TYPE:
740
ADDRESS:2910 TAM O'SHANTER DRIVETELEPHONE:
(916) 939-0962
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:6CENSUS: 4DATE:
09/08/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Omita KhanTIME COMPLETED:
11:26 AM
ALLEGATION(S):
1
2
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9
Staff left residents unattended
INVESTIGATION FINDINGS:
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2
3
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5
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8
9
10
11
12
13
Licensing Program Analyst (LPA) Kerry Hiratsuka arrived at the facility unannounced to conduct a Complaint Investigation Visit. LPA conducted COVID-19 Precautionary prescreening, and wore a surgical mask while at facility. LPA was screened by Caregiver.

LPA investigated the allegation “Staff left residents unattended.” LPA interviewed staff and all staff denied the residents were left unattended. All staff stated they worked their shifts. A couple of staff members went on vacation, but the rest all stated the shifts were covered. Two residents interviewed also stated there is a staff member here at all times.

Based on the above, the allegation is unfounded.
“This agency has investigated the complaint alleging; Staff left residents unattended. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis."
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
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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