097001962-4-30-2024-59-AS-LMUZ-D4VVN9-20240502163446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 097001962
Report Date: 04/30/2024
Date Signed: 04/30/2024 12:26:04 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/17/2024 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20240417120233

FACILITY NAME:	OAK GROVE SENIOR CARE		FACILITY NUMBER:	097001962
ADMINISTRATOR:	OMITA KAHN		FACILITY TYPE:	740
ADDRESS:	2920 TAM O'SHANTER DRIVE		TELEPHONE:	(916) 939-0962
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	6	CENSUS: 1	DATE:	04/30/2024
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Administrator Lenore Alexius		TIME COMPLETED:	12:25 PM

ALLEGATION(S):

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Staff interfered with the resident's right to make decision about their care
Facility is in disrepair, unsanitary and free from odor
Facility staff are not adequately trained to meet the needs of residents in care
Staff do not transfer resident in a safe manner
Staff do not provide daily activities for residents in care
Staff do not keep the facility free of mold
Staff do not have the equipment required to meet resident needs
Staff are not meeting resident's ALD need

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs) Muscan and Bains arrived at the care home and met with Administrator Lenore Alexius, to close the complaint into the allegations listed above.

The department conducted a walkthrough of the facility. The facility was clean, safe, sanitary, and free of mold and odor. Upon initial investigation it was discovered that the allegations for this complaint is for another facility. Although the complaint allegations are not related to this facility, the Department did not observe any issues with the facility physical plant.

The above allegations are found to be UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

No deficiencies are being cited. Exit interview conducted. A copy of the report provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024

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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