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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315001984
Report Date: 02/09/2024
Date Signed: 02/14/2024 10:35:41 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, 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
09/11/2023 and conducted by Evaluator Sarena Keosavang
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20230911115419
FACILITY NAME:BRIGHT HORIZONS CARE HOMEFACILITY NUMBER:
315001984
ADMINISTRATOR:BUCOVATI, SHEILAFACILITY TYPE:
740
ADDRESS:232 NERISSA COURTTELEPHONE:
(916) 746-0144
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:6CENSUS: 5DATE:
02/09/2024
UNANNOUNCEDTIME BEGAN:
11:51 AM
MET WITH:Administrator: Florin BucovatiTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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- Facility obtained a prescription for a resident without consent from resident's responsible party.
INVESTIGATION FINDINGS:
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LPA Keosavang, conducted this visit to change the findings from unfounded to substantiated. This reports supercedes the report done on 2/09/2024.

On 02/09/2024, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to deliver final finding Community Care Licensing (CCL) received on 09/11/2023. LPA met with administrator, Florin Bucovati, and explained the purpose of the visit.

During the course of the investigation, the Department conducted interviews with facility staff and obtained pertinent documents relevant to the complaint investigation such as residents’ (R1 and R2) physician’s report, incident reports, confidential facsimile transmittal, medication administration records, and medication list.

Continue on page LIC 9099-C.

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
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 5
Control Number 59-AS-20230911115419
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: BRIGHT HORIZONS CARE HOME
FACILITY NUMBER: 315001984
VISIT DATE: 02/09/2024
NARRATIVE
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Allegation: Facility obtained a prescription for a resident without consent from resident's responsible party. -Unfounded.

The Department conducted interviews and reviewed records to investigate the allegation that Facility obtained a prescription for a resident without consent from a resident’s responsible party. The Department reviewed R1’s physician’s report, medication list and medication administration records. According to the R1’s physician’s report, R1 is unable to administer their own prescription medication, administer their own PRN medication, and store their own medication.

The Department interviewed a total of five (5) facility staff and four (4) residents. Interviews indicated that R1 was seen by a physician at which time (1) one of resident’s medications were changed. Based on Title 22 regulations (§87465(a)(4) … The licensee shall assist residents with self-administered medications as needed.)

Additionally, there is no documentation that R1 is conserved therefore the facility is not required to obtain consent to administer medications to R1 as long as the medication administered are prescribed by a physician.

Based on records reviewed, facility observations and interviews the facility was following physician orders in administers all prescribed medication to R1 therefore the allegation listed above is UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted and report provided.

SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20230911115419
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: BRIGHT HORIZONS CARE HOME
FACILITY NUMBER: 315001984
VISIT DATE: 02/09/2024
NARRATIVE
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SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
09/11/2023 and conducted by Evaluator Sarena Keosavang
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20230911115419

FACILITY NAME:BRIGHT HORIZONS CARE HOMEFACILITY NUMBER:
315001984
ADMINISTRATOR:BUCOVATI, SHEILAFACILITY TYPE:
740
ADDRESS:232 NERISSA COURTTELEPHONE:
(916) 746-0144
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:6CENSUS: 5DATE:
02/09/2024
UNANNOUNCEDTIME BEGAN:
11:51 AM
MET WITH:Administrator: Florin BucovatiTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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9
- Facility is not serving nutritious meals to residents in care.
- Facility staff did not serve an adequate amount of food to residents in care.
INVESTIGATION FINDINGS:
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This report was ammended on 2/14/2024.

On 02/09/2024, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to deliver final finding Community Care Licensing (CCL) received on 09/11/2023. LPA met with administrator, Florin Bucovati, and explained the purpose of the visit.

During the course of the investigation, the Department conducted interviews with facility staff and obtained pertinent documents relevant to the complaint investigation such as resident’s (R1) physician’s report, admission agreement, preplacement appraisal information, consent for emergency medical treatment, and appraisal/needs and services plan.

Continue on page LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20230911115419
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: BRIGHT HORIZONS CARE HOME
FACILITY NUMBER: 315001984
VISIT DATE: 02/09/2024
NARRATIVE
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Allegation: Facility is not serving nutritious meals to residents in care. – Unsubstantiated.

According to interviews received, R1 was transferred to the hospital and sodium level was at 177. The facility was not serving low sodium and nutritious foods to R1. The Department interviewed a total of 5 facility staff and 4 residents in care. Interview statement received from S3 indicated staff ensures that the food provided to residents in care is balanced. S4 stated there is more than enough food available for the residents. S4 stated the portion size of the food is overwhelming. There is a lot of food and staff want to ensure residents eat and digest their food properly. Interview statement received from resident (R4) indicated meals are balanced. The Department reviewed R1’s physician’s report. The physician’s report indicated R1 is not on a special diet.

Allegation: Facility staff did not serve an adequate amount of food to residents in care. – Unsubstantiated.

The complainant was present at the facility and observed that the food was not appealing. There were slivers of dry chicken with vegetables and a side that was smashed. The complainant stated the food looked like it could be served to a 5-year-old because the portions were so small and R1 had gotten thin while in the facility’s care.

On 09/13/2023 at 12:30 PM, LPA Keosavang arrived at the facility unannounced to commence a complaint investigation during lunch time and observed 3 residents in care eating their lunch in the dining room area. LPA observed residents eating pasta, one slide, fruits, yogurt, water, and juice. LPA observed staff serving adequate amount of food to residents in care.

The Department interviewed a total of five (5) facility staff and four (4) residents. Interview statement received from staff (S1) indicated some residents barely touch their food, so they are given smaller portions. Residents may ask for larger portions. S2 stated there is a weekly meal calendar and staff would follow it. Residents in care are served protein, fruits, and vegetables. S3 indicated there is more than enough food available for the residents. Interview statement received from resident (R3) indicated, the facility provides a lot of fruits, pasta, and other things. R3 stated, “They give us way too much.” R3 stated that a lot of residents do not finish their food on the plate. Interview statement received from R4 indicated, the facility provides a lot of food, and the portion is too much. Food is loaded with fruits and vegetables.

Due to the information above, CCL finds the allegation to be UNSUBSTANTIATED, meaning 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.

An exit interview was conducted, and a copy of the report was left at the facility.

SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5