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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700641
Report Date: 07/06/2022
Date Signed: 07/06/2022 02:25:17 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
02/09/2022 and conducted by Evaluator Sarena Keosavang
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220209091103
FACILITY NAME:SOMERFORD PLACE-ROSEVILLEFACILITY NUMBER:
312700641
ADMINISTRATOR:TAYLOR, DEBORAHFACILITY TYPE:
740
ADDRESS:110 STERLING COURTTELEPHONE:
(617) 796-8350
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:64CENSUS: 37DATE:
07/06/2022
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Executive Director- Jane ScapparoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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- Staff have not followed emergency disaster plan.
- Facility gates are locked to the residents.
- Residents rooms have not been properly maintained while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility and met with Executive Director (ED), Jane Scaparro, to deliver complaint findings. LPA wore Surgical mask and was screened by facility upon entry.

Throughout the course of the complaint investigation the Department conducted interviews with facility staff and obtained pertinent documents relevant to the complaint allegations listed above.

Allegation: Staff have not follow emergecny disaster plan. - Unbsubstantiated.

The Department requested for facility's Fire Drill Training documents for review. According to ED, the facility was under a different management in 2021 and switched to a new management in October 2021.


************* Continue on LIC 9099-C. *****************
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
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 5
Control Number 25-AS-20220209091103
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: SOMERFORD PLACE-ROSEVILLE
FACILITY NUMBER: 312700641
VISIT DATE: 07/06/2022
NARRATIVE
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Fire Drill Training records indicated the facility conducted monthly Fire Drill Training on 01/30/2021, 02/11/2021, 03/31/2021, 04/30/2021,06/05/2021, and 06/26/2021. Maintenance Director, Jay Brown, conducted training on topics such as fire equipment functional, visual/audio devices checked, fire panel performed properly, follow-up corrective action- employee education/training, follow-up corrective action- disciplinary action, and head count of staff. Facility does not have records of Fire Drill Training from July 2021 through December 2021. Documents revealed that the facility has continued to conduct Fire Drill Training on 02/17/2022, 02/28/2022, and 06/29/2022. Interviews with a total of four (4) facility staff revealed that the facility's trainer went over facility's emergency disaster plan and conducted fire drills with staff.

Allegation: Facility gates are locked to the residents. - Unsubstantiated.
According to Complainant, facility has locked doors to prevent resident from using the courtyard. The Department interviewed a total of four (4) facility staff. Interview statements received from the four (4) facility staff indicated that doors used to go to the courtyard is locked. Residents would have to ask staff permission to use the courtyard for their safety. If a resident is out in the courtyard resident is able to enter the building at any time because the door is unlocked from the outside. On 7/6/2022, LPA and ED toured the courtyard together. LPA observed ED unlocked courtyard door with a key to go out into the courtyard, however, when going back into the the facility the door from the outside is unlocked.

According to Complainant, the gates located at each sides of the building is locked to residents and staff which poses a threat to staff and residents incase of an emergency evacuation. LPA observed two different locks on both sides of the gates. One lock requires a key to open the gate. According to ED, the Fire Department is the only one that has the key to unlock and open the gate. ED stated she had a conversation with the Fire Marshall who indicated that if there was an emergency the Fire Department is able to get the facility on time to cut lock and get everyone out if necessary. The other lock is a combination code lock which requires someone to enter numbers to unlock gate. According to staff and ED, staff has the numbers to unlock the gate.

SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
02/09/2022 and conducted by Evaluator Sarena Keosavang
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220209091103

FACILITY NAME:SOMERFORD PLACE-ROSEVILLEFACILITY NUMBER:
312700641
ADMINISTRATOR:TAYLOR, DEBORAHFACILITY TYPE:
740
ADDRESS:110 STERLING COURTTELEPHONE:
(617) 796-8350
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:64CENSUS: 37DATE:
07/06/2022
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Executive Director- Jane ScapparoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
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9
- Facility does not have an active administrator on the premises.
- Staff do not properly maintain the kitchen.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility and met with Executive Director (ED), Jane Scaparro, to deliver complaint findings. LPA wore Surgical mask and was screened by facility upon entry.

Allegation: Facility does not have an active administrator on the premises. - Unfounded.

According to ED, there was a change of management that took place in October of 2021. There were two Regional Support staff that was present at the facility to assist ED at the time she was in the process of obtaining an administrator's certificate. On 6/28/2022, LPA interviewed Regional Support staff, Rommel Aquino, who stated he and Evelyn Choi were present at the facility to provide support. LPA verified that Regional Support staff, Rommel Aquino, has an active administrator certificate on the DSS website.

Continue on page LIC 9099-C.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 25-AS-20220209091103
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: SOMERFORD PLACE-ROSEVILLE
FACILITY NUMBER: 312700641
VISIT DATE: 07/06/2022
NARRATIVE
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Allegation: Staff do not properly maintain the kitchen. - Unfounded.

On 2/15/2022, LPA Keosavang toured the interior and exterior of the facility together with ED. Areas toured include but are not limited to: common areas, five (5) resident bedrooms, three (3) bathrooms, and kitchen. LPA observed kitchen area kept clean and free of litter, rodents, vermin and insects. Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. Soaps, detergents, cleaning compounds or similar substances stored in areas separate from food supplies

This agency has investigated the complaint allegations listed above. The Department have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conduct and report provided to ED.

SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 25-AS-20220209091103
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: SOMERFORD PLACE-ROSEVILLE
FACILITY NUMBER: 312700641
VISIT DATE: 07/06/2022
NARRATIVE
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Allegation: Residents rooms have not been properly maintained while in care. - Unsubstantiated.

According to ED, Care staff are maintaining residents' bedrooms on a daily basis. Care staff's responsibility is to rinse the sinks, take out trash, and put everything away. On 02/15/2022, LPA toured the facility together with ED and observed five (5) residents rooms. LPA observed all residents rooms to be properly maintained. Interview statement received from care staff (S2) indicated, when regular care staff is not working at the facility because it's their days off and agency staff is covering, resident's rooms is unkempt.

LPA finds the allegation to be UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, and the findings are unsubstantiated.

Exit interview conducted. Copy of report provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5