572700714-8-6-2021-21-AS-KMOA-C6MT8B-20210907143005

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 572700714
Report Date: 08/06/2021
Date Signed: 08/06/2021 10:45:00 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/17/2021 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20210317161820

FACILITY NAME:	CAREWELL AT PISTACHIO LLC		FACILITY NUMBER:	572700714
ADMINISTRATOR:	PANTIG, PAULIN		FACILITY TYPE:	740
ADDRESS:	1125 PISTACHIO COURT		TELEPHONE:	(530) 759-2060
CITY:	DAVIS	STATE: CA	ZIP CODE:	95618
CAPACITY:	6	CENSUS: 5	DATE:	08/06/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Paulin Pantig		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Untrained staff

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

At approximately 9:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to deliver findings for the above allegation. LPA was met by Staff 1, and was asked Covid-19 screening questions and temperature was taken. LPA received copies of training records on 08/05/2021 that documented the required training hours for staff. At approximately 9:45AM, LPA reviewed additional training records at the facility. Staff are trained using a computerized training system as well as in person trainings that are conducted with a Vendorized instructor. Administrator Paulin Pantig arrived at approximately 10:25AM, and provided LPA with additional training records.
This agency has investigated the above allegation. 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.
No Citations issued during today's visit.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

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 1