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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880755
Report Date: 08/04/2022
Date Signed: 08/04/2022 11:11:55 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/29/2022 and conducted by Evaluator Stephanie Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220729163748
FACILITY NAME:SARAH'S GOOD LIFEFACILITY NUMBER:
331880755
ADMINISTRATOR:UATA, THOMASFACILITY TYPE:
740
ADDRESS:26171 FOUNTAIN BLEU DRIVETELEPHONE:
(951) 679-7454
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY:6CENSUS: 4DATE:
08/04/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Thomas Uata, AdministratorTIME COMPLETED:
10:21 AM
ALLEGATION(S):
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Lack of supervision resulting in residents leaving the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to initiate the investigation into the above allegation. The LPA met with Administrator, Thomas Uata, and informed him of the purpose of the visit.

On this visit the LPA toured the facility, conducted staff/resident interviews, reviewed records, and took copies of pertinent documentation. Regarding the allegation, "Lack of supervision resulting in residents leaving the facility," it was alleged residents with cognitive disabilities wandered outside of the facility and required the assistance of law enforcement to be returned to the home. Third party interviews revealed no knowledge of any residents in care wandering out of the facility in the last month. Resident interviews revealed no knowledge of residents leaving the facility without staff supervision. The Administrator was interviewed and revealed there was one resident, Resident One (R1), who did leave the facility approximately four (4) months ago without staff assistance. He reported he arrived within thirty (30) minutes in order to assist in the search of the resident, and later contacted law enforcement when the resident could not be redirected. A records review
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
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 2
Control Number 18-AS-20220729163748
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SARAH'S GOOD LIFE
FACILITY NUMBER: 331880755
VISIT DATE: 08/04/2022
NARRATIVE
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revealed R1 has left the facility unassisted on approximately one (1) other occasion in the year 2022. R1 is diagnosed with a cognitive impairment and has exhibited behavior which would require supervision. Due to a lack of information, this allegation is deemed UNSUBSTANTIATED at this time.

This report was reviewed with Uata and a copy was provided.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2