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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700157
Report Date: 12/20/2022
Date Signed: 12/20/2022 11:43:33 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
12/12/2022 and conducted by Evaluator Talwinder Bains
COMPLAINT CONTROL NUMBER: 25-AS-20221212102849
FACILITY NAME:CHALET, THEFACILITY NUMBER:
342700157
ADMINISTRATOR:PATEL, NISHAFACILITY TYPE:
740
ADDRESS:6487 MAIN STREETTELEPHONE:
(925) 787-2740
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:41CENSUS: 20DATE:
12/20/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria Susie Dizon-Administrator TIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff do not provide adequate hygiene service.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/20/2022, LPA Bains conducted unannounced visit to the facility to investigate the complaint with above allegation. LPA followed covid testing protocol, self screened to affirm that no covid-19 symptoms present. LPA wore N-95 mask during today's visit. LPA met with Maria Susie Dizon-Administrator and explained the purpose of the visit.

LPA conducted facility tour and interviewed 3 facility staff and 4 residents. Based on observations and interviews, it has been concluded that facility has adequate supplies for all hygine supplies including soap, toilet paper and paper towels. Furthermore, staff is providing assistance to residents with their hygiene needs per their care needs with no issues. Based on this, the above allegation is found to be UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

A copy of this report has been provided to facility. Exit interview conducted.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
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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