312700042-3-6-2025-59-AS-MSEY-DEVV3C-20250318160430

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700042
Report Date: 03/06/2025
Date Signed: 03/06/2025 03:56:41 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
10/30/2024 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20241030160128

FACILITY NAME:	SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	312700042
ADMINISTRATOR:	MEGAN GALLAGHER		FACILITY TYPE:	740
ADDRESS:	567 3RD STREET		TELEPHONE:	(916) 409-4150
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	132	CENSUS: 61	DATE:	03/06/2025
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Megan Gallagher		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are falsifying resident’s medication administration record
Staff do not ensure that resident's medication is administered as prescribed.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On March 6, 2025, Licensing Program Analyst (LPA) Kevin Mknelly spoke to Director, Megan Gallagher to deliver complaint findings for the above allegation.
LPA was accompanied by an observer from CCLD’s policy division.

The department reviewed resident records, facility records and conducted extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.

It was reported that on October 19, 2024 R1 did not receive as needed pain medications as prescribed and requested. Physician’s orders for R1’s pain medication states as needed every 4 hours for pain.
Statements alleged that at approximately 4:30 PM, On October 19, 2024, R1 requested pain medication. Med tech, S1, sought clarity of timing between R1’s medications before dispensing. Later in the evening, R1 again requested pain medication from S1. R1 alleged that medication was not dispensed at S1 left for water and did not return.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

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-20241030160128

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: 03/06/2025

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

Medication Administration records (MAR) and Controlled Drug records (CDR) for R1 were reviewed and found the following: The MAR had recorded controlled drug PRN dispensed to R1, on October 19^th at 5:25 PM. This was not a significant variation of the time periods for this medication for this resident.

While CCR regulations do require documentation of PRN medications administration, and inconsistencies were found between the MAR and CDR, additional evidence was not found to support that the inconsistencies were intentional or fraudulent.

As a result of this investigation, LPA finds allegation to be (US)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 with administrator.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2