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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700042
Report Date: 09/26/2024
Date Signed: 09/26/2024 12:24:35 PM

Substantiated


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
07/25/2024 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20240725172932
FACILITY NAME:SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
312700042
ADMINISTRATOR:MEGAN GALLAGHERFACILITY TYPE:
740
ADDRESS:567 3RD STREETTELEPHONE:
(916) 409-4150
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:132CENSUS: 66DATE:
09/26/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Megan GallagerTIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Resident wandered away from the facility due to lack of care and supervision
Staff billed resident for services not rendered
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Thursday September 26, 2024, to complete and deliver findings to a complaint received on 7/25/2024. LPA met with Administrator Megan and explained the purpose of the visit.

Throughout the course of the investigation, LPA interviewed the Administrator and staff. LPA reviewed R1’s physicians report, incident report, police report, resident assessment, monthly billing, email communication, and nursing notes. The result of the investigation is as follows:

Allegation: Resident wandered away from the facility due to lack of care and supervision.
At approximately 9pm on July 8, 2024, LPA learned that the delayed egress alarm on a second-floor door went off. Staff checked the alarm but did not check the hallway nor did they check to ensure all residents were accounted for. When the morning shift began on July 9, 2024, they noticed that R1 was not in the facility. Per the police report, the facility called in a missing person’s report at 7:36am. R1 was located 8:12am at a local business.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
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 5
Control Number 59-AS-20240725172932
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: 09/26/2024
NARRATIVE
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An immediate civil penalty of $500 was issued due to lack of supervision which led to R1's eloping and wandering away from the facility.

Allegation: Staff billed resident for services not rendered.

LPA reviewed R1’s assessment dated 6/11/2024 which shows that R1 needed the following care: status checks (16 per shift), psychosocial (behavioral interventions), dressing, laundry, medication assistance, and special care (exit seeking). This combination of care put R1 at a level 5 which was billed at $3,000 per month. On the night that R1 eloped from the facility, staff were assigned to complete 16 status checks per shift in addition to supervising R1 for exit seeking. Therefore, R1 was being billed for supervision that was not being provided at the time of the elopement.

Based on the information detailed above, LPA finds the allegations to be substantiated. A finding that the allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiency cited on 9099-D. Appeal rights were printed and given.

Exit interview conducted. A copy of this report was left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20240725172932
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2024
Section Cited
CCR
87705(c)(4)
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87705(c) (4) Care of Persons with Dementia. (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:
(4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and
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Facility previously submitted staffing training for regarding elopment. This citation is cleared upon the visit.
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health care needs as identified in his/her current appraisal. This requirement was not met as evidenced by R1 eloping from facility without staff knowledge. This posed a direct threat to the health and safety of resident in care.
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Type B
10/03/2024
Section Cited
CCR
87507(f)
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87507 Admission Agreements
(f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement is not met as evidenced by:
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Facility agrees to issue a refund for care and supervision for 7/8 and 7/9/2024.
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facility billing for care services which were not rendered between the days of 7/8/2024 and 7/9/2024 including frequent checks (16 per shift) and redirecting regarding exit seeking behavior. This posed an indirect threat to the health and safety of resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
07/25/2024 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20240725172932

FACILITY NAME:SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
312700042
ADMINISTRATOR:MEGAN GALLAGHERFACILITY TYPE:
740
ADDRESS:567 3RD STREETTELEPHONE:
(916) 409-4150
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:132CENSUS: 66DATE:
09/26/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Megan GallagherTIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Staff do not answer facility telephone
Staff did not keep resident's authorized person informed of a change in health condition
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Thursday September 26, 2024 to complete and deliver findings to a complaint received on 7/25/2024. LPA met with Administrator Megan and explained the purpose of the visit.

Throughout the course of the investigation, LPA interviewed the Administrator and staff. LPA reviewed R1’s physicians report, incident report, police report, resident assessment, monthly billing, email communication, and nursing notes. The result of the investigation is as follows:

Allegation: Staff did not keep resident's authorized person informed of a change in health condition
LPA reviewed resident notes which noted that R1 began to exit seek in May. LPA reviewed meeting invites and emails between R1’s POA and the facility, which show that the facility was communicating regarding R1’s exit seeking. R1 had documented behaviors of exit seeking beginning when R1 moved in in September 2023. Per Resident notes, the facility contacted the POA when needed due to R1’s behaviors. As R1’s exit seeking and wandering increased, the facility provided evidence of a scheduled
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20240725172932
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: 09/26/2024
NARRATIVE
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teleconference and frequent emails.

Allegation: Staff do not answer facility telephone
Title 22 regulations and California Health and Safety Code does not specify that staff are required to answer the facility phone. There is a regulation that states the resident has the right to reasonable access to telephones to both make and receive confidential calls. The regulation, however, does not define what reasonable is. The facility does have a receptionist between the hours of 8am until 8pm. A review of the resident's care plan does not have a time frame for staff to expect a phone call for the resident in question which is not required but could have helped to ensure the resident would get the phone call.

Based on information obtained, LPA finds the allegations 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.

Exit interview conducted. A copy of this report was left with the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5