315002819-10-15-2024-59-AS-KHOS-DA6RD7-20241018125527

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002819
Report Date: 10/15/2024
Date Signed: 10/15/2024 01:08:06 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, 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
10/10/2024 and conducted by Evaluator Cassandra Mikkelson

COMPLAINT CONTROL NUMBER: 59-AS-20241010090610

FACILITY NAME:	BRIDGEWAY SENIOR CARE, LLC		FACILITY NUMBER:	315002819
ADMINISTRATOR:	JACKSON, SAYEH		FACILITY TYPE:	740
ADDRESS:	313 WORDSWORTH COURT		TELEPHONE:	(916) 893-3099
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	6	CENSUS: 5	DATE:	10/15/2024
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Sayeh Jackson, Administrator		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Staff are not allowing resident to come back to the facility

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Cassandra Mikkelson and Michael Hood arrived at the facility and met with Administrator, Sayeh Jackson, to open a complaint investigation into the allegation listed above.

During today's visit, LPAs conducted interviews and review documentation pertinent to the investigation.

Relevant party (RP) reported that resident (R1) was admitted to the hospital on 10/1. RP stated that they had an agreement with the owner (Shay) that resident would only be at the hospital until 10/11. RP stated that they called the owner on 10/10 to discuss the discharge of R1 and the owner stated that they didn't want R1 back. RP stated that resident's belongings are still at the facility, and the owner is now ignoring theirs and the resident's calls.

** Report continued on 9099-C **

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassandra Mikkelson	TELEPHONE: 916-709-6830
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

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-20241010090610

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: BRIDGEWAY SENIOR CARE, LLC	FACILITY NUMBER: 315002819
	VISIT DATE: 10/15/2024

NARRATIVE

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Interview with Administrator, Sayeh Jackson, indicated that R1 was originally admitted to the facility on May 2021 and was discharged from facility on June 2024 due to going to the hospital/skilled nursing facility (SNF) for wound care. R1 was initially able to ambulate, but over time R1 became bedridden. Hospital discharged R1 to Roseville Care Center for continued care due to R1 needing more care than the facility could give to resident. Administrator stated that R1 had been last admitted to the facility on 9/25/2024. LPAs reviewed R1's Admission Agreement and observed R1 to be readmitted to the facility on 9/25/2024. Administrator stated that R1 was sent back to the hospital on 9/30/2024. R1 was admitted to a SNF again on 10/01/2024. Administrator stated that they spoke to Local Long Term Care Ombudsman (LTCO), Byron Toliver, on 10/10/2024 and spoke with Senior Care Solutions on 10/10/2024 regarding R1's placement after coming to an agreement with R1 that they would not be returning to the facility. Administrator stated that R1 has already been admitted to Amethyst Grove Assisted Living and R1's property was already removed the morning of 10/15/2024.

Interview with R1 indicated they were sent out to the hospital due to a pressure wound (stage II). The hospital started treatment for the pressure wound and then they were sent for further care at Roseville Care Center, where the pressure wound had progressed to stage IV. Per R1, they have no problem with Bridgeway Senior Care, LLC and does not know who would have filed a complaint against them. Bridgeway Senior Care, LLC has done a good job with their care since day one, and R1 has always had excellent care from care staff. R1 stated that Administrator Sayeh Jackson and R1 discussed that their care needs had changed (currently bedridden) and R1 agreed with Administrator to not return to the facility. LPA reviewed R1's file and observed that R1 is their own responsible party and can make all executive decisions for themselves. R1 states that communication with Administrator Jackson has always been great and R1 has always received all care needed. The Department determines that no eviction notice was necessary due to the information provided above.

Based on interviews conducted, observations, and records reviewed, the above allegation is found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassandra Mikkelson	TELEPHONE: 916-709-6830
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

LIC9099 (FAS) - (06/04)

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