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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001715
Report Date: 07/09/2021
Date Signed: 07/09/2021 01:57:36 PM

Unsubstantiated


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
07/13/2020 and conducted by Evaluator Arlene D Garcia
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20200713141330
FACILITY NAME:CARING FAMILIES-BV2FACILITY NUMBER:
347001715
ADMINISTRATOR:MICHELLE MACIASFACILITY TYPE:
740
ADDRESS:8716 BRAY VISTA WAYTELEPHONE:
(916) 686-0420
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 6DATE:
07/09/2021
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Michelle Macias, AdministratorTIME COMPLETED:
01:56 PM
ALLEGATION(S):
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Staff handled resident in a rough manner resulting in injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Arlene Garcia conducted an unannounced complaint visit on this day for the purpose of concluding a complaint investigation. On this day, LPA met with Administrator (AD) Michelle Macias and explained the reason for the visit.

The initial 10-day visit was conducted on 7/20/2020.

Through the course of the investigation, LPA conducted interviews, reviewed staff and resident records. It was alleged that staff handled resident in a rough manner resulting in injury. LPA interviewed five of 8 staff, interviewed 3 of 5 responsible party members. Of the interviews conducted, there was no report of concern for the care being provided from staff at the facility. LPA reviewed staff records and resident records. LPA reviewed records from a third party vendor that provided support to the resident in the facility and shows no documentation of concern over care the resident was receiving.

9099 Cont. >>>>>>>>>>>>>>>>>>>>>>>>

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arlene D Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
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-20200713141330
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: CARING FAMILIES-BV2
FACILITY NUMBER: 347001715
VISIT DATE: 07/09/2021
NARRATIVE
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9099 Cont. >>>>>>>>>>>>>>>>


Based on information provided through interviews and documentation, it was unclear as to whether staff handled resident in a rough manner resulting in injury. Therefore, the allegation was deemed UNSUBSTANTIATED, meaning that there was not a preponderance of evidence to prove or disprove that the allegation occurred as reported.

No deficiencies cited. An exit interview was conducted with Administrator Michelle Macias and a copy of this report was provided.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arlene D Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2