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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 11:17:55 AM

Unsubstantiated


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-20220722085838
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):
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9
Staff are not providing adequate food service to residents
INVESTIGATION FINDINGS:
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9
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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 are not providing adequate food service to residents.” LPA interviewed staff and two residents, and also inspected the food supply. One resident said the food was good and one stated it was bad. LPA was unable to interview the rest of the residents due to mental capacity. LPA observed fruits, frozen prepared foods, frozen raw chicken, fresh vegetables and other food items in the facility. LPA reviewed the menu.

Because there is a difference in the interviews, LPA cannot prove or disprove the allegation. The allegation is unsubstantiated.
Unsubstantiated
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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