312700823-12-9-2021-25-AS-KHOS-CAMLNH-20220113075422

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700823
Report Date: 12/09/2021
Date Signed: 12/09/2021 02:56:33 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
11/15/2021 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 25-AS-20211115082932

FACILITY NAME:	BRIDGEWAY SENIOR CARE		FACILITY NUMBER:	312700823
ADMINISTRATOR:	DUMITRASCUTA, NOEMI		FACILITY TYPE:	740
ADDRESS:	313 WORDSWORTH CT.		TELEPHONE:	(916) 893-3099
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	6	CENSUS: 6	DATE:	12/09/2021
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	China Strong, House Manager.		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Staff is rough with residents
Staff speaks inappropriately to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kerry Hiratsuka arrived at the facility unannounced on 11/17/20/2021 to conduct a Complaint Investigation Visit. LPA conducted COVID-19 Precautionary prescreening, and wore a surgical mask while at facility. LPA was screened by Caregiver.

LPA investigated the allegation “Staff is rough with residents; and Staff speaks inappropriately to residents.” LPA interviewed facility staff, residents, and reviewed a resident's file. ALl residents stated they are treated very well and none of the staff speak inappropriately to them.

“This agency has investigated the complaint alleging; Staff is rough with residents; and Staff speaks inappropriately to residents. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis."

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021

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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