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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701170
Report Date: 01/18/2024
Date Signed: 01/18/2024 03:27:58 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/18/2024 and conducted by Evaluator Tung Truong
COMPLAINT CONTROL NUMBER: 27-AS-20240118075103
FACILITY NAME:YOUNG AT HEART RCFE NO.4 INCFACILITY NUMBER:
342701170
ADMINISTRATOR:SISAYAN, LILLIANFACILITY TYPE:
740
ADDRESS:9012 COLOMBARD WAYTELEPHONE:
(916) 682-6080
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:6CENSUS: 5DATE:
01/18/2024
UNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Glenda MolinyaweTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff handled resident in a rough manner.
Facility staff fed a resident food that had dropped on the floor.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 1/18/24, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit at this facility to commence a complaint investigation with the allegations above. LPA met with administrator designee Glenda Molinyawe and explained the purpose of the visit.

During today’s visit, LPA conducted interviews and reviewed records. Based on interviews and records review, it was determined that the allegations above were false. LPA interviewed resident (R1), R1 corroborated that she has reported false accusations about staff because she was having a bad time. R1 stated that facility staff were very good to her.

As a result of this investigation, LPA finds the allegations above to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or was without a reasonable basis.

Exit interview was conducted and a copy of the report was provided upon exit.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
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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