312700555-10-31-2024-59-AS-TORZ-DB5ULH-20241118144042

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700555
Report Date: 10/31/2024
Date Signed: 10/31/2024 09:39:17 AM

Unfounded

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
10/21/2024 and conducted by Evaluator Graham Gunby

COMPLAINT CONTROL NUMBER: 59-AS-20241021142405

FACILITY NAME:	SUMMERSET LINCOLN ASSISTED LIVING		FACILITY NUMBER:	312700555
ADMINISTRATOR:	MEGAN GALLAGHER		FACILITY TYPE:	740
ADDRESS:	550 2ND ST		TELEPHONE:	(916) 644-3151
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	162	CENSUS: 95	DATE:	10/31/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Megan Gallagher		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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

INVESTIGATION FINDINGS:

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On 10/31/2024 , Licensing Program Analysts (LPA) Graham Gunby and Cheyenne Ratajczak arrived and met with Administrator to deliver investigation findings.

Based upon interview with the administrator and review of client roster, The department has determined the client does not reside in this facility and the complaint was made against the wrong facility. Therefore, the complaint is unfounded. The allegation is false, could not have happened, and/or is without a reasonable basis.

No deficiencies were cited during today's visit. An exit interview was conducted, and a copy of the report was given.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Graham Gunby	TELEPHONE: (916) 827-6870
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

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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