312700764-5-27-2021-25-AS-MSEY-C3FTFJ-20210528144139

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700764
Report Date: 05/27/2021
Date Signed: 05/27/2021 05:07:46 PM

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
04/23/2021 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-NP-20210423153636

FACILITY NAME:	SPLENDOR OAKS SENIOR LIVING 2		FACILITY NUMBER:	312700764
ADMINISTRATOR:	LEE, KEVIN		FACILITY TYPE:	740
ADDRESS:	6056 BIG BEND DR		TELEPHONE:	(916) 297-7141
CITY:	ROSEVILLE	STATE:	ZIP CODE:	95678
CAPACITY:	6	CENSUS: 4	DATE:	05/27/2021
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Eva Bogomaz and Latoya Scott, caregivers and Maria Cucicea, House Manager		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

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A resident is being overcharged fees for services.
Staff have denied resident access to personal belongings
Staff have injured a resident while providing care.
Staff did not treat resident with dignity and respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to continue investigation into the above allegations. LPA met with Eva Bogomaz, caregiver, who answered the front door. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted licensee and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask. Additionally, LPA was screened by Eva, prior to entering the facility. Resident (R1) was sleeping at the start of the inspection and was later interviewed after interviewing (3) other residents and (2) caregivers. House Manager, Maria Cucicea, arrived at approximately 3:30 pm.

During the course of the investigation, LPA interviewed the Administrator, House Manager, (2) caregivers and (4) residents. LPA also discussed the allegations with the Ombudsman who recently investigated them and with a family member/Power of Attorney (POA) of resident (R1). LPA reviewed documentation for resident (R1) including, but not limited to: Admission Agreement, physicia's report, pre-appraisal and care plan.

The results of the investigation are as follows:
cont on 9099C(1)...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021

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 25-NP-20210423153636

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: SPLENDOR OAKS SENIOR LIVING 2	FACILITY NUMBER: 312700764
	VISIT DATE: 05/27/2021

NARRATIVE

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9099C(1)..Allegation: A resident is being overcharged fees for services: Complaint alleges that resident is being charged an additional $500.00 monthly that what was agreed upon. LPA reviewed resident's Admission Agreement which states the monthly rent amount was effective 9/8/2020. Interview with resident's POA, who assisted in paying resident's bills, confirmed that the monthly rent charged was consistent with the amount stated in the admission agreement. Ombudsman's investigation showed that the facility is not overcharging resident and resident is being per the admission agreement. House Manager indicated that resident was actually not charged for specialty food items that are normally billed. Resident (R1) stated that she initially paid $500.00 less than the amount stated in the Admission Agreement. House Manager confirmed that is not correct information. Based on information obtained, LPA finds the allegation to be UNFOUNDED-

Allegation: Staff have injured a resident while providing care. Complaint alleges staff is rough with resident, slam her walker and the shower head dropped on resident due to staff being rough. All staff interviews indicated that resident has not fallen or been injured by staff. Staff stated that resident uses a walker and had some bruises on her lower left leg from the way she uses the walker. Resident's POA indicated that the facility staff has treated resident very well and is not aware of any resident being handled roughly. Resident's family member stated that the shower head did hit resident but it was an accident and no injuries were incurred. All residents interviewed indicated that staff treats them very well and have never witnessed any residents to be mistreated by staff. Resident (R1) stated the shower head previously hit her head and then it was repaired by the facility. Resident (R1) stated she has bruises on her legs from the wheelchair she uses. House Manager stated the shower head was never broken to her knowledge. Based on information obtained, LPA finds the allegation to be UNFOUNDED-

Allegation: Staff have denied resident access to personal belongings. Complaint alleges that facility staff have taken resident's phone away. All staff interviews and interview with resident's POA indicated that staff did not take resident's phone away but resident's family member did, temporarily, after resident was making numerous non-emergency phone calls to 9-1-1. Resident was given a replacement cell phone by her family shortly after the first cell phone was taken away. Ombudsman indicated that resident stated to him that her family had taken the cell phone away since she had called 9-1-1- twice the night before. Resident (R1) stated that staff took her cell phone and wouldn't let her use it. Based on information obtained, LPA finds the allegation to be UNFOUNDED-

cont on 9099C(2)..

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021

LIC9099 (FAS) - (06/04)

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Control Number 25-NP-20210423153636

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: SPLENDOR OAKS SENIOR LIVING 2	FACILITY NUMBER: 312700764
	VISIT DATE: 05/27/2021

NARRATIVE

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Allegation: Staff did not treat resident with dignity and respect. Complaint alleges that facility staff are rude with resident. All interviews with staff and resident's POA indicated that staff always treats resident (R1) with dignity and respect and they have never observed any other resident to be treated without dignity and respect. Additionally, (3) residents interviewed indicated that staff has always treated them with dignity and respect, provides the care they need and have never witnessed any resident being treated disrespectfully by any staff. Resident (R1) stated that staff is not always respectful to her and do not have a good bedside manner some of the time. Resident did not want to state which staff but stated they were not currently at the facility. Based on information obtained, LPA finds the allegation to be UNFOUNDED-

Based on information obtained, LPA finds the above (4) allegations to be UNFOUNDED- meaning the allegation is false, could not have happened and/or is without a reasonable basis.

Exit interview with Eva Bogomaz since House Manager had to leave facility at 4:45 pm for an appointment. Copy of report provided to facility.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021

LIC9099 (FAS) - (06/04)

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