397004497-1-11-2023-27-AS-LKIG-CNCQWU-20230123113232

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397004497
Report Date: 01/11/2023
Date Signed: 01/11/2023 10:04:36 AM

Substantiated

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
01/04/2023 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230104085640

FACILITY NAME:	NEW HOPE GUEST HOME-ALPINE		FACILITY NUMBER:	397004497
ADMINISTRATOR:	ROBERT FELIX		FACILITY TYPE:	740
ADDRESS:	3008 W. ALPINE AVENUE		TELEPHONE:	(209) 941-0519
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95204
CAPACITY:	6	CENSUS: 6	DATE:	01/11/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Pedro Cajas		TIME COMPLETED:	10:20 AM

ALLEGATION(S):

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Facility staff did not seek residents hotel accommodations for an extended period of time after power outage.

INVESTIGATION FINDINGS:

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Refer to Case Management on 01/03/2023 and 1/06/2023 for deficiencies. Based on information contained in the case management listed above this allegation is SUBSTANTIATED.

Based on LPA Johnson's observation of residents on 01/03/2023. The allegation has been determined to be SUBSTANTIATED. A finding of substantiated means that the preponderance of evidence standard has been met.

Deficiencies were cited in case management done on 01/06/2023. Failure to correct deficiencies may result in the issuance of civil penalties.

An exit interview was conducted and a copy of this report and appeal rights was left at facility.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

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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