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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312701032
Report Date: 07/14/2025
Date Signed: 07/14/2025 03:11:41 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/20/2024 and conducted by Evaluator Todd Tryon
COMPLAINT CONTROL NUMBER: 59-AS-20241120102803
FACILITY NAME:AMI HOUSING, INC.FACILITY NUMBER:
312701032
ADMINISTRATOR:JENNIFER PRICEFACILITY TYPE:
735
ADDRESS:1720 LILAC LANETELEPHONE:
(530) 878-5088
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:15CENSUS: 13DATE:
07/14/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Brooke Hegel, Administrator; Danielle MartinTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Medication errors.
INVESTIGATION FINDINGS:
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On 7/14/2025 LPA Tryon visited the facility to complete the complaint. LPA met with Administrator Brooke Hegel and Facility Lead Staff Danielle Martin During the course of the investigation LPA has spoke with staff, reviewed Medication Records, and conducted pill counts. On 11/25/2024 a count was done of medications for Resident R1. In reviewing the pills present and Medication Administration Records (MARS) LPA found that R1 basically had 2 prescription medications present as per MAR. One medication had pills in 2 separate bottles. It appears that a new bottle was started before the first one was finished. However, when both bottles were added together and compared to the MAR, the count did come out correct. However, the other medication had more pills in the bottle than should have been there as per MAR. It was also found that there were several split or partical pills in the bottle. The medication was to be given in doses of a whole pills, so it is unclear what may have happened, as there should not have been partial pills. At any rate, it appears there were too many pills by a count of several pills (split pills were broken unevenly, so it was impossible to tell what took place). Therefore, there was a medication error in count, The allegation is Substantiated. A finding of substantiated means that the preponcerance of the evidence standard has been met. The following deficiency is cited as per Title 22 Regulations. Appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/20/2024 and conducted by Evaluator Todd Tryon
COMPLAINT CONTROL NUMBER: 59-AS-20241120102803

FACILITY NAME:AMI HOUSING, INC.FACILITY NUMBER:
312701032
ADMINISTRATOR:JENNIFER PRICEFACILITY TYPE:
735
ADDRESS:1720 LILAC LANETELEPHONE:
(530) 878-5088
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:15CENSUS: DATE:
07/14/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Brooke Hegel, Administrator; Danielle MartinTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Facility did not adhere to the Admission Agreement.
INVESTIGATION FINDINGS:
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Regarding the allegation that Facility did not adhere to the Admission Agreement, this was in reference to the facility allegedly not consulting with the "case manager" before making the decision to do an eviction notice. There was no designated "case manager" for resident R1. The legal conservator maintained that since there is not a designated case manager, that roll falls to the conservator. In reviewing the Conservatorship documents for R1, LPA could find no reference to the Conservator acting as case manager. Also, the conservator was very involved in the case of R1 and was made aware of issues going on. There may not have been any formal documenatation of a "consultation" regarding eviction; but there was also no formal documentation naming the conservator as the case mananger. There appears to have been some misunderstanding about this issue from all parties involved. So, although it appears that the facility was in contact with the conservator regarding issues, it's not clear if all parties understood the rolls. Therefore, the Department finds the allegation to be Unsubstantiated. A finding of unsubstantiated means 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. Exit interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20241120102803
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: AMI HOUSING, INC.
FACILITY NUMBER: 312701032
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/14/2025
Section Cited
CCR
80075(b)
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(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.
This requirement was not met as evidence by:through review of medication records and pill count, LPA found that errors were made in dose of medication for resident R1, as
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The facility shall ensure that residents are assisted to self-administer medications as prescribed by physician.
Staff were re-trained upon giving medications on 12/5/2024 and routine pill counts were intitiated by Administrator.
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the pill county did not match the medication record, as there were too many pills left in the container compared with the medication record; and there were several "split" pills present, when medication should have been given as a whole pill each time.
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POC complete.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3