312700128-4-26-2023-25-AS-LMUZ-CRMSVL-20230508141251

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700128
Report Date: 04/26/2023
Date Signed: 04/26/2023 12:26:13 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
02/15/2023 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 25-AS-20230215154840

FACILITY NAME:	LOVE YOU DAD II		FACILITY NUMBER:	312700128
ADMINISTRATOR:	NECULA, MONICA		FACILITY TYPE:	740
ADDRESS:	6200 SWEETGRASS COURT		TELEPHONE:	(916) 223-9762
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95677
CAPACITY:	8	CENSUS: 6	DATE:	04/26/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Monica Necula, Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility has staff working with no criminal background clearance
Staff are using illegal drugs while on duty
Residents are chemically restrained with medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to investigate complaint. LPA met with Monica Necula during today's inspection.

During the compliant investigation LPA interviewed staff, reviewed facility documents, and inspected 6 of 6 resident medications. LPA investigated allegation, "Facility has staff working with no criminal background clearance". LPA reviewed staff files, and reviewed facility association list. LPA observed that all staff are associated to the facility roster, and have valid ID's. Due to information gathered, LPA finds allegation to be unfounded.

Continuation on 9099-C.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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 25-AS-20230215154840

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: LOVE YOU DAD II	FACILITY NUMBER: 312700128
	VISIT DATE: 04/26/2023

NARRATIVE

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LPA investigated allegation, "Staff are using illegal drugs while on duty". LPA interviewed 3 staff and conducted a facility tour which included the staff room. LPA did not observe any illegal drugs or evidence of drug use. LPA interviewed caregivers on shift, and caregivers stated they have not used illegal drugs or seen other staff members use illegal drugs. LPA interviewed administrator in which she stated she has not had any staff use illegal drugs while on duty. Due to information gathered LPA finds allegation to be UNFOUNDED.

LPA investigated allegation, "Residents are chemically restrained with medication". LPA conducted a medication review in which LPA reviewed current resident medications with doctor orders. LPA observed all medications available to residents are prescribed by their physician with specific directions, and times to take medications. LPA interviewed caregivers, in which she stated she follows physician directions when giving medications to residents. LPA interviewed administrator in which she stated all medications are given to residents as prescribed. If a PRN medication is provided to resident, staff document date, time, and results of PRN for the resident. LPA observed all medications are stored in a locked cabinet in the kitchen area. LPA toured facility and did not observe any other medications in the facility. LPA was unable to interview residents due to diagnosis. Due to the information gathered LPA finds allegation to be UNFOUNDED.

The allegation is UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC9099 (FAS) - (06/04)

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