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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700901
Report Date: 09/09/2021
Date Signed: 09/09/2021 03:29:42 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, 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
07/14/2021 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 25-AS-20210714120704
FACILITY NAME:A LOVING AND JOYFUL HOME RCFEFACILITY NUMBER:
312700901
ADMINISTRATOR:HEYDON, ANITAFACILITY TYPE:
740
ADDRESS:609 HERNANDEZ LANETELEPHONE:
(916) 200-8447
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 5DATE:
09/09/2021
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Ram PratapTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Licensee engaged in a verbal altercation in the presence of residents.

Licensee is providing care and supervision to a relative who resides in the home.
INVESTIGATION FINDINGS:
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On 9/9/21 at 2:00 PM, Licensing Program Analyst (LPA) Cheng conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with caregiver. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; and completed a facility risk assessment upon arrival. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by caregiver.

LPA conducted records review and interviews.
LPA is unable to find and or meet the preponderance, per policy.

Licensee acknowledged that they and a family member occasionally have animated conversations yet stated that they are sure to have those conversations away from other residents. Others who were interviewed did not report witnessing or being disturbed by the licensee and family interactions.
Report continued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
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 2
Control Number 25-AS-20210714120704
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: A LOVING AND JOYFUL HOME RCFE
FACILITY NUMBER: 312700901
VISIT DATE: 09/09/2021
NARRATIVE
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While the licensee does provide as needed assistance to a family member when that family member is at the facility, the licensee has not exceeded the facility's capacity and there was no evidence found that the assistance provided to the family member effects the care provided to residents. There are circumstances that warrant further discuss with the licensee and CCL. An office meeting is to be scheduled to discuss this issue further.

As a result of this investigation, LPA finds allegation to be (US)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 was conducted and report copy provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2