312700574-10-30-2024-59-AS-MSEY-DAYNCT-20241113092112

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700574
Report Date: 10/30/2024
Date Signed: 10/30/2024 03:04:19 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
10/25/2024 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 59-AS-20241025105323

FACILITY NAME:	ANSEL PARK SENIOR LIVING COMMUNITY		FACILITY NUMBER:	312700574
ADMINISTRATOR:	PAYNE, KEITH		FACILITY TYPE:	740
ADDRESS:	1200 ORCHID DRIVE		TELEPHONE:	(916) 250-0770
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95765
CAPACITY:	100	CENSUS: 72	DATE:	10/30/2024
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Keith Payne, Executive Director		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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-Staff do not ensure that facility faucets deliver hot water

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, 10/30/24, and met with the Executive Director, Keith Payne, to open a complaint investigation into the above stated allegation. LPA delivered findings as well.

During today's visit, LPA conducted interviews and checked the water temperature in five (5) apartments in Assisted Living and two (2) apartments in Pathways Memory Care. The water temperature was within the regulatory range of 105-120 degrees F in four (4) of five (5) apartments in Assisted Living and one (1) of two (2) apartments in Memory Care. Apartment #100 bathroom sink took approximately 15 minutes to indicate a water temperature of 104 degrees F. LPA rechecked the temperature later in the visit and it was 107.1 degrees F. Apartment #168 had a water temperature of 78.6 degrees F in the kitchen sink. Apartment #179 had a water temperature of 103 degrees F in the bathroom sink.
************************************************Continued on LIC9099-C*************************************************

Substantiated

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: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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 3

Control Number 59-AS-20241025105323

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: 10/30/2024

NARRATIVE

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Interview with resident (R1) indicated that they had been having issues with their water temperature heating up for approximately a week prior to them moving to a new apartment. Interview with Administrator indicated that the facility has been working to repair the water temperature issue in apartment #169. Administrator indicated that R1 signed a residency agreement amendment to move apartments to resolve the issue of not receiving hot water. Interview with resident (R4) indicated that their water takes quite some time to heat up. Residents (R2 & R3) stated that they always have hot water.

During today's visit, LPA observed a plumber working on the water temperature issue in apartment #169. Interview with the Maintenance Director indicated that the plumbing business first began their service to repair the water temperature issue on 10/23/24. According to the plumbing company invoice, with a work order date of 10/23/24, on 10/24/24, they "arrived to unit #169 pulled and replaced the shower cartridge. Did not fix water temperature issue. Tried to adjust settings on cartridge but no issues. Inspected water heater running fine. Turned up setting on recirculation pump". The work order also indicated that on 10/25/24 the plumbing company "came back and problem was still occurring ran more tests in the unit. Problem with the way it is plumbed. Replaced shower cartridge and still had issues with water temperature. Will give estimate to replace shower valve". Maintenance Director indicated that the plumbing company will provide another invoice after today's visit, which will be provided to LPA.

Interview with Administrator indicated that they are going to schedule an appointment with the vendor that repairs any issues with the water heaters to ensure there are no issues with the water heaters. LPA observed the three (3) waters heaters and they were set at 129 degrees F. LPA reviewed the facility temperature log, which indicated that the Maintenance Director checked eleven (11) locations' water temperatures in the facility the week of 10/1/24. They checked five (5) locations' water temperatures the week of 10/8/24 and three (3) the week of 10/15/24. All the temperature checks were within regulatory standards. The log does not indicate any temperature checks were conducted the week of 10/22/24.

Based on observation, interviews conducted, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page.

Exit interview conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20241025105323

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/30/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/13/2024 Section Cited CCR 87303(e)(2)	1 2 3 4 5 6 7	87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Facility agrees to contact the vendor that would repair any issues with the water heaters to ensure they are in good repair and continue working with the plumbing company to resolve water temperature issues. Facility agrees to provide LPA with all work orders regarding repairs as well as a current water temperature log by the POC due date of 11/13/24. LPA will return on a later date to recheck the water temperature.
	8 9 10 11 12 13 14	Based on observation, interviews, and records reviewed, the facility did not ensure that two (2) of seven (7) residents' apartments are receiving hot water, which poses a potential health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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