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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 097003692
Report Date: 08/15/2022
Date Signed: 08/25/2022 11:35:48 AM

Unfounded


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
04/27/2022 and conducted by Evaluator Todd Tryon
COMPLAINT CONTROL NUMBER: 25-AS-20220427102210
FACILITY NAME:ROYAL GARDENFACILITY NUMBER:
097003692
ADMINISTRATOR:DIZON, MARIA SUSIEFACILITY TYPE:
740
ADDRESS:2961 WARREN LANETELEPHONE:
(916) 939-6940
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:6CENSUS: 3DATE:
08/15/2022
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:TIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not showering resident timely.
Food is not of appropriate quantity to meet resident's needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/15/2022 LPA Tryon arrived at the facility at 3:00 p.m. to work on the complaint. LPA had done a self-screening for COVID symptoms prior to the visit, used hand sanitizer, and temperature was taken upon arrival. LPA wore a sugical mask.
LPA interviewed staff. Staff contacted Licensee Shirley Dizon who arrived a few minutes later. At this time, LPA has interviewed staff and available residents. LPA learned that the resident involved moved to a nother facility, and has passed away, so LPA was not able to speak with that resident. In speaking with available resident, no issues were noted, resident received showers timely and regularly, food was good and plentifful. LPA noted good supplies of food in the home. LPA also reviewed records of resident showers. At this time, there is no evidence to show that the staff does not shower residents; and there is no evidence to prove that residents do not receive adequate food. Allegations are UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened, and/or is wihtout a reasonable basis.
No deficiencies were cited at this visit. Exit interview conducted.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022
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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