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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701138
Report Date: 10/24/2023
Date Signed: 10/24/2023 03:41:46 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/19/2023 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230719160621
FACILITY NAME:COMFORTS OF HOME LAGUNA PARKFACILITY NUMBER:
342701138
ADMINISTRATOR:KANG, MARIAFACILITY TYPE:
740
ADDRESS:5721 LAGUNA PARK DRIVETELEPHONE:
(916) 833-1493
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:6CENSUS: 6DATE:
10/24/2023
UNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Teresita EstebanTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Resident was touched inappropriately by a staff member.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski spoke with facility administrator Maria Kang over the phone and explained the purpose of the visit. Kang said staff member Teresita Esteban could sign this report in her absence.

This investigation consisted of interviews, record review, and observations. Interviews were held with Kang, two staff members, residents of the facility, a resident’s (R1) conservator, and an ombudsperson.

During an interview, a resident (R1) was unable to provide details regarding an alleged incident of inappropriate touching by a staff member (S1). R1 said “everything is fine.”

During an interview, S1 denied any inappropriate touching. S2 did not believe the alleged incident had occurred. Three other residents interviewed did not express concerns regarding S1 or regarding the facility.
[continued on 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
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 27-AS-20230719160621
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: COMFORTS OF HOME LAGUNA PARK
FACILITY NUMBER: 342701138
VISIT DATE: 10/24/2023
NARRATIVE
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An Elk Grove Police Department report stated that R1 told officers during a visit on 7/19/23 that R1 had not been touched inappropriately.

The department has determined the following as it relates to the allegation that a resident was touched inappropriately by a staff member:

Based on observation, interviews, and record review, the above allegation is UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was left with Esteban.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2