315002198-4-24-2023-59-AS-MSEY-CR8TP5-20230425145343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002198
Report Date: 04/24/2023
Date Signed: 04/24/2023 12:15:31 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/28/2023 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230328182351

FACILITY NAME:	HAPPY LIFE VILLA		FACILITY NUMBER:	315002198
ADMINISTRATOR:	PARVU, ELENA-COCA		FACILITY TYPE:	740
ADDRESS:	2233 DONOVAN DRIVE		TELEPHONE:	(916) 749-9253
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	6	CENSUS: 4	DATE:	04/24/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Elena Parvu		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Residents are chemically restrained with medication
Facility staff not fingerprint-cleared
Staff are using drugs while on duty
Facility staff are abusing residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melissa Parks arrived unannounced to complete and deliver findings to a complaint received on 3/28/23. LPA met with Administrator Elaine and explained purpose of visit.
LPA interviewed the Administrator and 2 staff. LPA reviewed medication orders for (4) residents. LPA also toured the facility and observed all residents 3/30/2023 and 4/24/2023. The results of the investigation are as follows:

Allegation: Residents are chemically restrained with medication.
All staff indicated that residents are only administered medications that are prescribed by their physician. The resident interviewed stated that they have had no issues with their medication. Addtionally, the resident stated that they do not take any medications to assist with sleeping.There are no PRN or OTC medication given for sleep aids. LPA reviewed current medication lists. No medications listed (nor observed at the facility) are for sleep aids. LPA observed ordered medications to be given as ordered and no errors for residents (R1 and R4).

Unfounded

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

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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Control Number 59-AS-20230328182351

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: HAPPY LIFE VILLA	FACILITY NUMBER: 315002198
	VISIT DATE: 04/24/2023

NARRATIVE

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Allegation: Facility staff not fingerprint- cleared.

LPA reviewed staff files for (3) staff, including photo ID, and observed that all staff are fingerprinted cleared and associated. LPA obtained a staff roster which indicated there had not been any staffing changes over the past 12 months.

Allegation: Staff are using drugs while on duty.

Complaint alleges that staff are using drugs while on duty. Based on interviews with staff and LPA's observations on 3/30/2023 and on 4/24/23, staff were observed to be competently assisting residents and able to perform their jobs.

Allegation: Facility staff are abusing residents.

Based on interviews with staff and resident in addition to LPA's observations on 3/30/2023 and on 4/24/23, staff are not abusing or neglecting residents. Residents appeared to be groomed and well cared for. LPA observed (4) residents watching television during inspection on 3/30/2023 and did not observe any physical bruising on any residents.

Based on information obtained, LPA finds the allegations to be UNFOUNDED- means that the allegations are false, could not have happened, and/or are without a reasonable basis.

Exit interview. A copy of this report was emailed to the Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

LIC9099 (FAS) - (06/04)

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