486803974-4-24-2023-21-AS-KMOA-CRAMEJ-20230427093248

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803974
Report Date: 04/24/2023
Date Signed: 04/24/2023 05:55:02 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/22/2023 and conducted by Evaluator Karina Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20230222133208

FACILITY NAME:	L & S GENTLE CARE II		FACILITY NUMBER:	486803974
ADMINISTRATOR:	PADAMA, SAMUEL		FACILITY TYPE:	740
ADDRESS:	778 APPALOOSA CT		TELEPHONE:	(707) 846-1100
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	6	CENSUS: 6	DATE:	04/24/2023
		UNANNOUNCED	TIME BEGAN:	04:13 PM
MET WITH:	Imelda "Mel" Garcia, Facility Manager		TIME COMPLETED:	06:05 PM

ALLEGATION(S):

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Facility failed to issue a refund

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Karina Canela arrived unannounced for the purpose of delivering complaint findings on complaint 21-AS-20230222133208. LPA met with Imelda "Mel" Garcia, Facility Manager.
During the investigation LPA conducted interviews, reviewed documents requested. Complainant alleged that after resident, R1 passed away on 02/15/2023, R1's personal belongings were removed from the facility on 03/08/2023 or 03/09/2023, but they were not issued a refund in the correct amount. Facility stated belongings were removed on 02/25/2023. Facility issued a refund check on 02/15/2023 which was within the 15 days required by regulation.

This Agency has investigated the complaint alleging "facility failed to issue a refund". We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted with Imelda "Mel" Garcia, Facility Manager. *No deficiencies cited.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

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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