<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 097002991
Report Date: 09/17/2024
Date Signed: 09/17/2024 01:29:45 PM

Unsubstantiated


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
07/17/2024 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20240717125107
FACILITY NAME:NEW WEST HAVEN IIFACILITY NUMBER:
097002991
ADMINISTRATOR:TANIA LANGLANDFACILITY TYPE:
740
ADDRESS:2551 CAMEO DRIVETELEPHONE:
(530) 677-2979
CITY:CAMERON PARKSTATE: CAZIP CODE:
95682
CAPACITY:67CENSUS: 34DATE:
09/17/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Jennifer ScarberryTIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure that resident had a working call pendant while in care.
Staff did not ensure that resident's showering needs were met while in care.
Staff did not ensure that resident's clothing needs were met while in care.
Staff did not ensure that resident's hygiene needs were met while in care.
Staff did not ensure that resident was provided with clean bedding while in care.
Staff did not ensure that resident's room was maintained in a sanitary condition.
Staff do not adhere to resident's special diet.
Staff did not respond to resident's requests for assistance in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/17/24, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Jennifer Scarberry.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia MuscanTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
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 2
Control Number 59-AS-20240717125107
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: NEW WEST HAVEN II
FACILITY NUMBER: 097002991
VISIT DATE: 09/17/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Staff did not ensure that resident's showering needs were met while in care.
Staff did not ensure that resident's clothing needs were met while in care.
Staff did not ensure that resident's hygiene needs were met while in care.
Staff did not ensure that resident was provided with clean bedding while in care.
Staff did not ensure that resident's room was maintained in a sanitary condition.
Based on interviews, record reviewed and observation it was determined that the facility is meeting residents showering, laundry, and hygiene needs, based on the residents needs and service plan. LPA toured the facility on 7/24/24 and 9/10/24 and did not find any dirty bedding, smells, or dirty rooms. Seven (7) resident interviews stated the caregivers/staff clean the facility, the bedding, the resident clothes and take out trash frequently. Additionally, six (6) staff and seven (7) resident interviews did not indicate any issues at the facility with cleanliness, sanitation, toilets, resident rooms, and other areas. Based on all this information, the allegations are found to be UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Staff did not ensure that resident had a working call pendant while in care.
Staff did not respond to resident's requests for assistance in a timely manner.
Based on interviews, record reviewed and observation it was determined that all pendants are checked on the office monitor which alert staff when batteries need to be changed. Additionally, staff always check resident pendants, especially the ones that do not regularly use them. Staff (6) interviews and seven (7) resident interviews indicated that pendants work when they are being used. Seven (7) resident interviews stated that staff respond within a reasonable amount of time when the pendants are used. Six (6) staff interviews stated that the response time for pendants being pressed range between immediately to 10 min based on current situation. Based on all this information, the allegations are found to be UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Staff do not adhere to resident's special diet.
Department conducted interviews with seven (7) residents and six (6) staff to investigate this allegation. Interviews indicated that residents were happy with dietary services at facility and did not indicate any issues. Interviews also indicated that the cook accommodates the dietary needs and restrictions of residents in care based on their needs and service plan. Based on all this information, the allegation is found to be UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Exit interview was conducted with Administrator and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia MuscanTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2