275294322-4-3-2022-26-AS-KHOS-CDENMA-20220412103448

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275294322
Report Date: 04/03/2022
Date Signed: 04/03/2022 05:16:17 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,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/10/2022 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 26-AS-20220110092324

FACILITY NAME:	PARK LANE, THE		FACILITY NUMBER:	275294322
ADMINISTRATOR:	BEAU A. AYERS		FACILITY TYPE:	740
ADDRESS:	200 GLENWOOD CIR		TELEPHONE:	(831) 373-0101
CITY:	MONTEREY	STATE: CA	ZIP CODE:	93940
CAPACITY:	160	CENSUS: 194	DATE:	04/03/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Lori Trindade Sales Director		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Facility is unclean
Facility failed to meet residents hygiene needs
Insufficient staffing
untrained staff

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 4/3/22 at 12:00pm to conclude the complaint investigation. Upon arrival LPA met with Lori Trindade, Sales Director and stated the purpose of the visit. Lori Trindade contacted the Administrator Beau Ayers via phone and LPA requested a call from the Administrator. The Administrator contacted LPA who restated the purpose of the visit.

In regards to allegation,"Facility is unclean" and "Facility failed to meet residents hygiene needs", LPA observed feces in the toilet bowl of Resident #1 (R1)'s room and a minute amount of dust on the hardwood floor but not on the wood furniture. Based on interviews of staff, (R2) tends to use (R1)'s bathroom frequently during there visits with each other. R1 has an accessible balcony and it is unclear if the dust on the floor came from the door being opened. In review of R1's file (assessment dated 6/25/2020), it was observed that R1 is independent for bathing, dressing, grooming, toileting, and special care and there are no fees assessed for these services.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2022

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 26-AS-20220110092324

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: PARK LANE, THE	FACILITY NUMBER: 275294322
	VISIT DATE: 04/03/2022

NARRATIVE

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In regards to allegation, "Insufficient staffing" and "untrained staff" LPA obtained information through interviews that staff has worked extra hours to cover a shift but at no time did any staff need to work alone. There is 2 staff who works in the memory care unit as well as a floater. All staff interviewed concur that training is provided upon hire. Based on interviews with staff there is no lack of staff at this time.

Based on interviews conducted today and the lack of evidence, the preponderance of evidence standards has not been met; therefore, the above allegation(s) 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.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2022

LIC9099 (FAS) - (06/04)

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