312700042-9-28-2023-59-AS-MSEY-CWBSQN-20231005140500

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700042
Report Date: 09/28/2023
Date Signed: 09/28/2023 12:35:02 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
03/10/2023 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230310160924

FACILITY NAME:	SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	312700042
ADMINISTRATOR:	MARK MORRIS		FACILITY TYPE:	740
ADDRESS:	567 3RD STREET		TELEPHONE:	(916) 409-4150
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	132	CENSUS: 67	DATE:	09/28/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Mark Morris		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility is not adhering to Covid-19 masking protocols.
Facility is not adhering to Covid-19 quarantining/isolation protocols.
Facility is not adhering to Covid-19 testing protocols.
Facility does not provide staff with adequate PPE.

INVESTIGATION FINDINGS:

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LPA Parks arrived on Thursday September 28, 2023, to conclude a complaint investigation regarding the above allegations. LPA met with Administrator Mark and explained the purpose of the visit.

Throughout the course of the investigation, LPA interviewed the Administrator and facility staff. LPA reviewed the facility’s Infection Control Plan. Additionally, at the time the complaint was filed, LPA conducted a facility walk-through. The result of the investigation is as follows.

Throughout the facility walk-though, LPA observed (and took photos) of PPE supply. Facility has cases of N95 masks, surgical masks, gloves, gowns, and face shields. LPA also observed cases of covid-tests. LPA observed PPE carts in the hallway of covid positive residents. LPA observed cases of individual bottles of hand sanitizer and large hand sanitizer stations (in the hallway and mounted on the wall). LPA observed covid positive residents to be quarantined in their apartments, as much as possible, in a memory care unit. LPA observed staff wearing PPE when entering covid positive apartments.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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 59-AS-20230310160924

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: SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 312700042
	VISIT DATE: 09/28/2023

NARRATIVE

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LPA obtained an updated copy of the covid positive and covid negative residents. Per the facility, all residents will be retested in two days. LPA interviewed staff who stated they had access to full PPE to provide care for covid positive residents.

Based on information obtained during the investigation, LPA finds the allegations to be UNSUBSTANTIATED- a finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred,

Exit interview. A copy of this report was emailed to the Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

LIC9099 (FAS) - (06/04)

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