312700555-7-22-2022-25-AS-APEZ-CH5L8L-20220809083205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700555
Report Date: 07/22/2022
Date Signed: 07/22/2022 02:47:58 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/15/2022 and conducted by Evaluator Jacob Williams

COMPLAINT CONTROL NUMBER: 25-AS-20220715113557

FACILITY NAME:	SUMMERSET LINCOLN ASSISTED LIVING		FACILITY NUMBER:	312700555
ADMINISTRATOR:	MORRIS, SHALON		FACILITY TYPE:	740
ADDRESS:	550 2ND ST		TELEPHONE:	(916) 644-3151
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	162	CENSUS:	DATE:	07/22/2022
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Denise Carrillo, temporary Business Office Manager		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident’s room has an odor.
Resident unable to sleep due to disturbing noise.
Facility dining room has flies.
Facility door is locked from resident to enter.
Resident’s waiting for a period of time for door to be unlocked.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jacob Williams arrived at the facility unannounced on 07/22/2022 to open the complaint investigation for above allegations. LPA met with Denise Carrillo, who is filling in as Business Office Director as the Executive Director and Business Office Director are both out, and explained the purpose of the visit. Prior to the visit , LPA completed required COVID-19 testing protocols and the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA wore the following Personal Protective Equipment (PPE) during today's visit: surgical mask.

During today’s visit, LPA spoke with resident (R1), staff (S1, S2, and S3), toured the facility including areas of particular interest, and reviewed documents.

The results of the investigation are as follows:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob Williams	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

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-20220715113557

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SUMMERSET LINCOLN ASSISTED LIVING	FACILITY NUMBER: 312700555
	VISIT DATE: 07/22/2022

NARRATIVE

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Allegation: Resident’s room has an odor.
There is no odor present in R1's room. R1 states it was temporary because her trash had not been taken out. When LPA arrived, the trash was empty and there was no identifiable odor.

Allegation: Resident unable to sleep due to disturbing noise.
LPA toured the area of the third floor and was unable to hear any noises, or "beeping". R1 states the sound is now gone is no longer disturbing her sleep.

Allegation: Facility dining room has flies.
LPA toured the dining room and was not able to identify any flies. There are blue lights fixed on the walls of the dining area to attract and kill bugs in the area. The dining room appeared to be very clean and in good condition.

Allegation: Facility door is locked from resident to enter.
The front entrance door is unlocked during normal business hours while there is a front desk staff to screen visitors. Front desk staff goes home around 6:30pm. After this time, the doors have an automatic lock when attempting to enter the facility from the outside. There are two ways to enter the facility during this time:1) call the number posted on the entrance door which goes directly to the Med Tech and ask for entry; or 2) ring the doorbell beside the door which sends an alert to the MedTech and the caregivers. Once alerted, staff will walk to front door and allow the resident inside. Residents do not often leave out of the front entrance unless they are gone with family as the courtyard is the common area for residents to get fresh air.

Allegation: Resident’s waiting for a period of time for door to be unlocked.
See previous paragraph for explanation of front entry door after normal business hours. It will sometimes take a short amount of time for staff to reach the front door to respond to the doorbell after-hours.

Based on information obtained during the investigation, LPA finds the allegation 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 evidence to prove that the alleged violation occurred,

Exit interview. Copy of report provided.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob Williams	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

LIC9099 (FAS) - (06/04)

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