405801960-5-2-2022-29-AS-KBUY-CE3LAD-20220503083459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405801960
Report Date: 04/09/2022
Date Signed: 05/02/2022 02:04:16 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/18/2022 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20220318104745

FACILITY NAME:	BOB & CORKY'S CARE HOME III		FACILITY NUMBER:	405801960
ADMINISTRATOR:	DEBORAH COLE		FACILITY TYPE:	740
ADDRESS:	2456 SANTA CLARA		TELEPHONE:	(805) 400-0506
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	6	CENSUS: 5	DATE:	04/09/2022
		UNANNOUNCED	TIME BEGAN:	02:38 PM
MET WITH:	Joel Wobrock, Licensee		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident is not allowed visitors.

INVESTIGATION FINDINGS:

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This is an amended report. On 4/09/2022 at 2:38 pm, Licensing Program Analyst (LPA) Chavez conducted an unannounced complaint follow-up visit to deliver final findings. LPA met with Joel Wobrock, Licensee and explained the purpose of the visit.

Regarding the allegation “Resident is not allowed visitors,” the complainant’s concern was the facility was “limiting visitation.” To investigate the allegation, LPA interviewed the Licensee, R1, complainant, and reviewed facility records.

Continued on 9099-C>

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2022

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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Control Number 29-AS-20220318104745

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BOB & CORKY'S CARE HOME III	FACILITY NUMBER: 405801960
	VISIT DATE: 04/09/2022

NARRATIVE

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This is a continuation of the amended report.

On 4/08/2022 at 4:32 pm, LPA spoke with the complainant. The complainant was concerned that the facility was encouraging 30-minute indoor visits for unvaccinated visitors, and instead encouraged outdoor visits to limit exposure. LPA explained the current COVID-19 visitation guidance to the complainant. The complainant confirmed they had been allowed to visit Resident 1 (R1). The complainant also noted they disagreed with the fact that R1 moved into the facility instead of remaining in R1’s home.

On 3/22/2022 at 10:30 am, LPA interviewed the licensee. Licensee stated that R1 receives visitors and explained they encourage outdoor visitation due to COVID-19 because they feel it is safer.

On 3/22/2022 at 10:55 am, LPA spoke with R1. R1 relays that R1 has a POA. R1 explains that they regularly have visitors including family members. R1 says R1 does not know of anyone else who is not permitted to visit.

On 3/22/2022 at 10:45 am, LPA reviewed facility records. Visitor logs from 3/19/22 through 3/21/22 indicate that R1 had visitors on four different occasions since R1’s admission.

Based on interviews and record review, the allegation “Resident is not allowed visitors,” is deemed Unsubstantiated.

Exit interview conducted and a copy of the report emailed to Licensee.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2022

LIC9099 (FAS) - (06/04)

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