<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700823
Report Date: 03/08/2022
Date Signed: 03/08/2022 11:40:30 AM



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
12/22/2021 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 25-AS-20211222135642
FACILITY NAME:BRIDGEWAY SENIOR CAREFACILITY NUMBER:
312700823
ADMINISTRATOR:DUMITRASCUTA, NOEMIFACILITY TYPE:
740
ADDRESS:313 WORDSWORTH CT.TELEPHONE:
(916) 893-3099
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:0CENSUS: 6DATE:
03/08/2022
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Chynna StrongTIME COMPLETED:
11:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff neglected resident resulting in resident being malnourished
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Kerry Hiratsuka and Lavinia Muscan arrived at the facility unannounced on 03/08/2022 to conduct a Complaint Investigation Visit to deliver the results of the allegation above. LPAs conducted COVID-19 Precautionary prescreening, and wore a surgical mask while at facility. LPAs were screened by Caregiver.

LPA Hiratsuka, investigated the allegation “Staff neglected resident resulting in resident being malnourished.” LPA interviewed facility staff, responsible party of the resident, reviewed the resident's file, and observed the resident in the facility. There was constant contact between the facility, responsible party, and doctor. Proof of the communication was submitted by the facility administrator. The resident had a medical condition that was being treated and the resident started declining due to the medical condition. Medical records from the hospital does not indicate the resident is malnourished.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
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 2
Control Number 25-AS-20211222135642
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: BRIDGEWAY SENIOR CARE
FACILITY NUMBER: 312700823
VISIT DATE: 03/08/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
“This agency has investigated the complaint alleging; Staff neglected resident resulting in resident being malnourished. 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."
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2