312700574-5-9-2024-59-AS-MSEY-D5AQ7H-20240515115508

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700574
Report Date: 05/09/2024
Date Signed: 05/09/2024 04:39:52 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
05/06/2024 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 59-AS-20240506134242

FACILITY NAME:	ANSEL PARK SENIOR LIVING COMMUNITY		FACILITY NUMBER:	312700574
ADMINISTRATOR:	DEBORAH TAYLOR		FACILITY TYPE:	740
ADDRESS:	1200 ORCHID DRIVE		TELEPHONE:	(916) 250-0770
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95765
CAPACITY:	100	CENSUS:	DATE:	05/09/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Deborah Taylor, Executive Director		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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-Residents' rooms are not being kept clean and sanitary

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced today, 5/9/24, and met with the Executive Director, Deborah Taylor, to open and deliver complaint investigation findings into the above stated allegation.

During today's visit, LPA toured five (5) residents' (R1, R2, R3, R4 and R5) apartments and interviewed the Maintenance Director.

**********************************************Continued on LIC9099-C****************************************************

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

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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Control Number 59-AS-20240506134242

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: ANSEL PARK SENIOR LIVING COMMUNITY	FACILITY NUMBER: 312700574
	VISIT DATE: 05/09/2024

NARRATIVE

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LPA observed that R1, R2, R3, R4, and R5's apartments had clean floors, furniture, counter tops, cabinets, toilets, showers, and windows. The garbage bins were empty and the rooms were dust free. All rooms appeared to be clean, safe, sanitary and in good repair. LPA also observed cleaning staff cleaning residents' rooms.

Interview with the Maintenance Director indicated that there are currently 2 cleaning staff that clean residents' rooms 7 days per week. Interview indicated that each of the 2 cleaning staff have 8 rooms to clean everyday. The weekly cleaning includes the kitchen, bathrooms, bedroom, living room, sheets, towels, counter tops, floors, toilets, showers, and emptying the trash bins. Interview also indicated that the 2 cleaning staff do a deep cleaning of the residents' rooms monthly, which includes dusting (blinds, windows, and hard furniture) and cleaning the refrigerator and microwave.

Based on observation and interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies are being cited.

Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

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