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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700338
Report Date: 11/24/2021
Date Signed: 11/24/2021 10:41:55 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, 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
07/27/2021 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 25-AS-20210727155253
FACILITY NAME:SIGNATURE LIVING ON STORY RIDGE WAYFACILITY NUMBER:
342700338
ADMINISTRATOR:RIMANDO, NORAFACILITY TYPE:
740
ADDRESS:8400 STORY RIDGE WAYTELEPHONE:
(916) 300-5363
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:6CENSUS: 6DATE:
11/24/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Nerry Rimando-Afable, AdministratorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff sexually abused resident while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Nerry Rimando-Afable, to deliver findings into the complaint allegation listed above. Facility currently does not have any COVID-19 positive cases. LPA wore N-95 mask and was screened by facility upon entry. Facility staff wore masks in the care home.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

Allegation: Staff sexually abused resident while in care

** Report continued on 9099-C **
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2021
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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Control Number 25-AS-20210727155253
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: SIGNATURE LIVING ON STORY RIDGE WAY
FACILITY NUMBER: 342700338
VISIT DATE: 11/24/2021
NARRATIVE
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Resident (R1) reported that staff member (S1) had touched R1’s genital area over their clothing. R1 pushed S1’s hand away and told them to stop. R1 also alleged that S1 had attempted to remove R1’s underwear while assisting R1 with showering. R1’s statement regarding sexual abuse coincides with prior statements made by R1 and provided to Sacramento County Sheriff’s Department.

S1 denied touching R1’s genital area or doing anything inappropriate with R1. S1 reported that R1 refused to remove their underwear while showering and S1 did not interfere with R1 keeping their underwear on while showering.

Interviews conducted with staff indicated that no staff member had witnessed the alleged incident and staff did not have any complaints against S1. Interviews conducted with residents indicated that no resident had direct knowledge of the alleged incident and residents did not have any concerns regarding the care provided by S1. Sacramento County Sheriff’s Department suspended their case regarding the alleged incident.

Based on interviews conducted by the Department and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation 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 with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2021
LIC9099 (FAS) - (06/04)
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