315002339-8-7-2024-59-AS-MSEY-D83NTY-20240812104527

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002339
Report Date: 08/07/2024
Date Signed: 08/07/2024 10:42:33 AM

Unsubstantiated

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
04/25/2024 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20240425134600

FACILITY NAME:	GARDEN VILLA		FACILITY NUMBER:	315002339
ADMINISTRATOR:	KAUR, KANWALPREET		FACILITY TYPE:	740
ADDRESS:	1104 NOTTINGHAM COURT		TELEPHONE:	(916) 871-4682
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95661
CAPACITY:	6	CENSUS: 4	DATE:	08/07/2024
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	caregiver		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff does not ensure resident is allowed to have visitors.

INVESTIGATION FINDINGS:

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On 8/7/24, Licensing Program Analysts (LPA) Kevin Mknelly and Graham Gunby conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with designee caregiver. LPA soke with the Administrator by phone.

LPA conducted records review and extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.

On or about 4/14/24, R1 made a phone call to family. Reportedly R1 made statements to family that R1 was placed in the home against R1’s wishes and that R1 is being denied visits and phone access.
R1 was interviewed by the Ombudsman and reportedly made similar statements that R1’s spouse was limiting access by R1 to R1’s sister and daughter.
LPA interviewed R1, R1’s wife, R1’s sister and the Ombudsman during the course of the investigation.
Report continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

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-20240425134600

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: GARDEN VILLA	FACILITY NUMBER: 315002339
	VISIT DATE: 08/07/2024

NARRATIVE

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Records review for R1 found R1 to be diagnosed by R1’s primary physician as having Alzheimer's and bi-polar disorder.
On 5/7/24, LPA interviewed R1. R1 stated that R1 is not being held against his will at the facility and that for the time being R1 does not wish to have calls or visits while R1 is focused on getting better. R1 stated to LPA that he does not know why R1 made those previous statements.
On 5/7/24, LPA interviewed the Administrator. Administrator stated that R1 knew that R1 could make phone calls from the facility phone. After R1 took the phone of another resident to call R1’s family on 4/14/24, Administrator asked R1 why R1 did not ask for the facility phone. R1 reportedly stated that R1 did not know why R1 did that.

Between 5/7/24 and the conclusion of this investigation, attempts by family to call or write to R1 were told to R1 and mail was delivered to R1 and R1 chose to not respond to family contact.

The investigation found that while R1 at times made conflicting statements regarding his wishes or the wishes of others, conclusive evidence was not presented that the facility restricted R1’s right to visits, calls or personal mail.

R1 has since moved out of the facility.

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is 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 with designee, Mario Lantao and report provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

LIC9099 (FAS) - (06/04)

Page: 2 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
04/25/2024 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20240425134600

FACILITY NAME:	GARDEN VILLA		FACILITY NUMBER:	315002339
ADMINISTRATOR:	KAUR, KANWALPREET		FACILITY TYPE:	740
ADDRESS:	1104 NOTTINGHAM COURT		TELEPHONE:	(916) 871-4682
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95661
CAPACITY:	6	CENSUS: 4	DATE:	08/07/2024
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	caregiver		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff does not ensure resident is allowed to have visitors.

INVESTIGATION FINDINGS:

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On 8/7/24, Licensing Program Analysts (LPA) Kevin Mknellyand Graham Guby arrived and met with caregiver designee to deliver investigation findings.

LPA reviewed facility records, and conducted interviews.
LPA finds that facility met Tittle 22 requirements.

The investigation found that R1 had not received any attempted visitors that were denied access to visit R1.

This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted and report provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

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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