312700739-6-9-2023-25-AS-LMUZ-CSYN58-20230620100907

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700739
Report Date: 06/09/2023
Date Signed: 06/09/2023 09:47:51 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/12/2022 and conducted by Evaluator DeAnna Williams-Lyons

COMPLAINT CONTROL NUMBER: 25-AS-20220712132307

FACILITY NAME:	PINES, THE		FACILITY NUMBER:	312700739
ADMINISTRATOR:	HENRY COLE		FACILITY TYPE:	740
ADDRESS:	500 W RANCHVIEW DRIVE		TELEPHONE:	(916) 672-5019
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95765
CAPACITY:	142	CENSUS:	DATE:	06/09/2023
		UNANNOUNCED	TIME BEGAN:	08:59 AM
MET WITH:	Henry Cole, Executive Director		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility did not conduct a pre-admission appraisal on resident in care.
Facility did not conduct a pre-admission appraisal on resident in care.
Resident is not provided access to a phone while in care.
Resident is not being permitted to receive mail while in care.
Resident is not being accorded privacy while in care.

INVESTIGATION FINDINGS:

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On June 9, 2023, Licensing Program Analyst, (LPA) DeAnna Williams-Lyons arrived unannounced to deliver findings for complaint #25-AS-20220712132307. LPA met with Mira Marcus, BusinessOffice Director, and informed her the reason for the visit. The department received a complaint on July 22, 2022 alleging facility did not conduct a pre-admission appraisal on resident in care, Resident is not being allowed visitations while in care, resident is not being allowed visitation, resident is not provided access to a phone, resident is not being permitted to receive mail, and resident is not being accorded privacy.

LPA has reviewed facility files, interviewed residents, staff, witnesses. Residents 1 and 2 are a married couple who reside together at the facility. R1 and R2 were admitted to the facility on 08/26/2021. Based on records review, the facility conducted a pre-admission appraisal for R1 and R2 as well as all completed all other required documentation at the time of admission. Allegation is UNFOUNDED.

To continue see 9099-C...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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-20220712132307

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: PINES, THE	FACILITY NUMBER: 312700739
	VISIT DATE: 06/09/2023

NARRATIVE

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Based on interviews, R1 and R2 receive visitation and are accorded privacy while in care. R1 and R2 usually decline visits from certain visitors, however, R1 and R2 do have privacy with visitors when they come to the facility. Interviews indicate R2 gets very agitated when visitors come to visit. The facility decided to allow the visits to take place in the lobby or dining room because to assist with R2’s agitation. Witnesses interviewed stated on several occasions, certain visitors of R1 and R2 have tried to enter the Memory Care Unit without proper authorization, causing a scene in the front lobby and requiring staff to ask visitors to leave the facility. 7 of 7 staff interviewed stated that to be true. Allegations are UNFOUNDED.

According to staff and witnesses, R1 and R2 are not being denied their mail. R1 and R2 do not use the US Postal Service due to their medical conditions therefore R1 and R2’s mail is forwarded to an authorized representative. Allegation is UNFOUNDED.

This agency has investigated the complaint alleging the facility did not conduct a pre-admission appraisal on residents in care, resident is not being allowed visitations, resident is not provided access to a phone, resident is not being permitted to receive mail, and resident is not being accorded privacy and based on LPA’s observations, documents reviewed and staff, witnesses and residents interviewed, we have found that all allegations are UNFOUNDED, meaning that the allegations are false, could not have happened and/or is without a reasonable basis.

Per California Code of Regulations, Title 22, no citations were issued. An exit interview was conducted, and a copy of this report was given to Henry Cole.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC9099 (FAS) - (06/04)

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