312700042-9-15-2020-27-AS-APEZ-BTKRWH-20200918132306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700042
Report Date: 09/15/2020
Date Signed: 09/15/2020 03:17:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/30/2020 and conducted by Evaluator Melissa Lusby

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200430114634

FACILITY NAME:	SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	312700042
ADMINISTRATOR:	BOYLE, SABRINA		FACILITY TYPE:	740
ADDRESS:	567 3RD STREET		TELEPHONE:	(916) 409-4150
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	132	CENSUS: 67	DATE:	09/15/2020
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Sabrina Boyle		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff is sexually abusing resident
Staff did not adequately supervise resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst Melissa Lusby contacted the facility via telephone to deliver findings for the complaint investigation via telephone due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call and the elements of the allegations. The Department reviewed facility notes, resident file, and conducted relevant party interviews, obtained relevant documentation and evidence.

The investigation was unable to determine if staff sexually abused R1 and if staff did not adequately supervise R1.

The department notes that R1 was admitted to the facility with a diagnosis of Dementia with behavioral disturbances with and a history of confusion, disorientation, aggressive and wandering behavior.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Melissa Lusby	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2020

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-20200430114634

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 312700042
	VISIT DATE: 09/15/2020

NARRATIVE

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Both daughters of R1 were interviewed. Both expressed periods of delusions and hallucinations with their mother. Neither believed their mother was sexually assaulted. R1 had a documented history of wandering and wanting to leave the facility. Additionally, both daughters believe their mother was not attempting to take her life, rather just trying to leave the facility.

Four staff were interviewed including Executive Director, Resident Services Director, med tech, and caregiver. All interviewed acknowledged that R1 was frequently trying to leave the facility. No staff heard R1 vocalize she was sexually assaulted or raped. All interviewed stated R1 would often hallucinate or experience periods of 'sun downing' where she would become extremely confused.

The following documents were reviewed: unusual incident reports. staffing schedules, admission agreement, physicians reports (2), nursing notes, hospice notes, care plan, and narrative charting.

The Department finds the allegations of: Staff is sexually abusing resident and Staff did not adequately supervise resident to be UNSUBSTANTIATED. A finding that the complaint allegations is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit Interview conducted. Appeal rights were given. Copy of this report provided to facility representative.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Melissa Lusby	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2020

LIC9099 (FAS) - (06/04)

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