312700019-7-29-2021-27-AS-MSEY-C5HUD5-20210802152857

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700019
Report Date: 07/29/2021
Date Signed: 07/29/2021 02:31:08 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

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

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20210303095423

FACILITY NAME:	TERRACES OF ROSEVILLE, THE		FACILITY NUMBER:	312700019
ADMINISTRATOR:	JASMINE RIDENOUR		FACILITY TYPE:	740
ADDRESS:	707 SUNRISE AVE		TELEPHONE:	(916) 786-3277
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95661
CAPACITY:	199	CENSUS: 105	DATE:	07/29/2021
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Administrator, Ryan Mussato		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Personal rights.
Lack of supervision resulting in resident wandering away from the facility.
Lack of staff training.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melana Llopis conducted an unannounced complaint investigation visit to deliver complaint findings 07/29/2021. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA completed a facility risk assessment upon arrival at the facility. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by receptionist.

Throughout the investigation, the Department conducted onsite visits and conducted interviews relevant to the allegations listed above.
Results are as follows:

***LIC9099-C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

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 27-AS-20210303095423

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: TERRACES OF ROSEVILLE, THE	FACILITY NUMBER: 312700019
	VISIT DATE: 07/29/2021

NARRATIVE

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Allegation: Personal rights
Complaint alleged staff (S3) was yelling at residents in care. On 07/28/2021 LPA Mknelly visited the facility and conducted interviews with staff, S1 and S2 who have been working at the facility for multiple years. Staff denied personal rights of residents were violated. Staff stated they have not witnessed or encountered issues with residents wandering away from the facility. Staff statements and records reviewed indicate residents in which the complaint alleged were transferred out of the community in December 2020 and August 2020 due to change of conditions. Staff stated residents (R1 and R2) were experiencing confusion and wandering but did not go to the extent of exit seeking. Staff also stated during the last year the facility hired staff from an outside agency. Administrator stated they assumed the staff had the proper training provided to them by the agency. The facility could not provide confirmation of staff's training. No further evidence could be provided.

Allegation: Lack of supervision resulting in resident wandering away from the facility.
Complaint alleged residents R1 and R2 were wandering away from the facility. On 07/28/2021 LPA Mknelly visited the facility and conducted interviews with staff, S1 and S2 who have been working at the facility for multiple years. Staff denied personal rights of residents were violated. Staff stated they have not witnessed or encountered issues with residents wandering away from the facility. Staff statements and records reviewed indicate residents in which the complaint alleged were transferred out of the community in December 2020 and August 2020 due to change of conditions. Staff stated residents (R1 and R2) were experiencing confusion but did not go to the extent of exit seeking. Staff also stated during the last year the facility hired staff from an outside agency. Administrator stated they assumed the staff had the proper training provided to them by the agency. The facility could not provide confirmation of staff's training form the outside agency. LPA Mknelly reviewed a sample of staff training and found staff (S4) had required training. No further evidence could be provided.

***Continuation on LIC-9099 C***

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20210303095423

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: TERRACES OF ROSEVILLE, THE	FACILITY NUMBER: 312700019
	VISIT DATE: 07/29/2021

NARRATIVE

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Allegation: Lack of staff training.
Complaint alleged residents R1 and R2 were wandering away from the facility. On 07/28/2021 LPA Mknelly visited the facility and conducted interviews with staff, S1 and S2 who have been working at the facility for multiple years. Staff denied personal rights of residents were violated. Staff stated they have not witnessed or encountered issues with residents wandering away from the facility. Staff statements and records reviewed indicate residents in which the complaint alleged were transferred out of the community in December 2020 and August 2020 due to change of conditions. Staff stated residents (R1 and R2) were experiencing confusion but did not go to the extent of exit seeking. Staff also stated during the last year the facility hired staff from an outside agency. Administrator stated they assumed the staff had the proper training provided to them by the agency. The facility could not provide confirmation of staff's training form the outside agency. LPA Mknelly reviewed a sample of staff training and found staff (S4) had required training. No further evidence could be provided.

Based on the information provided, the Department finds the allegations listed above to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, and the findings are unsubstantiated.

An exit interview was conducted. No deficiencies were cited on today’s date.
Copy of report and appeal rights provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

LIC9099 (FAS) - (06/04)

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