097003692-5-3-2022-25-AS-LMUZ-CEGTA4-20220516143253

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 097003692
Report Date: 05/03/2022
Date Signed: 05/03/2022 10:49:00 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/15/2022 and conducted by Evaluator Michael Smith

COMPLAINT CONTROL NUMBER: 25-AS-20220215141835

FACILITY NAME:	ROYAL GARDEN		FACILITY NUMBER:	097003692
ADMINISTRATOR:	DIZON, MARIA SUSIE		FACILITY TYPE:	740
ADDRESS:	2961 WARREN LANE		TELEPHONE:	(916) 939-6940
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	6	CENSUS: 6	DATE:	05/03/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Shirley Dizon		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility does not ensure that resident is adequately fed.

Facility lacked a basic food item.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Prior to entering the facility, LPA Smith spoke with staff to pre-screen that the facility is COVID free. Analyst also self-screened for having no known symptoms or exposure. Analyst followed facility's screening protocols, wore a mask and maintained distance during the visit. LPA Smith conducted an unannounced complaint visit and met with Shirley Dizon.

Based on the investigation, there is no evidence that the facility is not feeding residents and lacking basic food items. Facility is well stocked with various foods/snacks, 10 loaves of bread was observed in the refrigerator, other residents were interviewed and none had any complaints about the food or the amount of food given. Based on this, the allegations of facility does not ensure that resident is adequately fed and facility lacked a basic food item are 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.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Michael Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3