342701172-1-6-2023-27-AS-KHOS-CN8RSK-20230119121653

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701172
Report Date: 01/06/2023
Date Signed: 01/06/2023 09:46:52 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, 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
12/29/2022 and conducted by Evaluator Christopher Hopkins-Clarke

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20221229140707

FACILITY NAME:	YOUNG AT HEART RCFE NO.5 INC		FACILITY NUMBER:	342701172
ADMINISTRATOR:	SISAYAN, ISAGANI		FACILITY TYPE:	740
ADDRESS:	8039 CAYMUS DRIVE		TELEPHONE:	(916) 681-3689
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95829
CAPACITY:	6	CENSUS: 5	DATE:	01/06/2023
		UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	Glenda Molinyawe		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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-Facility refused to take resident back from the Hospital

INVESTIGATION FINDINGS:

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On 1/6/23 at 9:02AM, Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced facility visit in regards to a complaint investigation with the above allegation. LPA Hopkins met with Administrator Glenda Molinyawe and explained the purpose of today's visit.

Regarding the allegation of Facility refused to take resident back from the Hospital, the Department found the following: based on interview, it was determined that when Licensee was notified Resident 1 (R1) was ready for discharge, Licensee wanted to get information on how to handle R1's medical diagnosis when returned back to the facility. Licensee and case manager agreed on pickup date which was scheduled for 12/30/22. R1 was picked up and returned to the facility on 12/30/22.

The department has investigated the above allegation and has determined that it is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
Exit Interview was conducted, and a copy of this report was provided to the facility.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

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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