315002894-6-6-2023-59-AS-LMUZ-CSTNSG-20230615104308

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002894
Report Date: 06/06/2023
Date Signed: 06/06/2023 01:26:05 PM

Unsubstantiated

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
05/11/2023 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20230511155138

FACILITY NAME:	GOLDEN HILLS CARE HOME		FACILITY NUMBER:	315002894
ADMINISTRATOR:	MAHAJAN, VIVEK		FACILITY TYPE:	740
ADDRESS:	1434 ELM STREET		TELEPHONE:	(916) 474-4920
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95678
CAPACITY:	6	CENSUS: 4	DATE:	06/06/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Vivek Mahajan		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility staff did not properly change resident's diaper.
Facility staff did not respond to resident's call button.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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-20230511155138

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: GOLDEN HILLS CARE HOME	FACILITY NUMBER: 315002894
	VISIT DATE: 06/06/2023

NARRATIVE

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***report continued from LIC9099...........

Allegation- Facility staff did not properly change resident's diaper.

Department interviewed 2 staff and 2 residents during complaint investigation. Department has reviewed facility records, including charting notes, staff schedule, and resident records. Interviews and record review indicated that resident’s ADL’s which includes residents showering, incontinence and care needs are met as required and documented accordingly. Residents’ interviews indicated that staff were providing care in a professional manner and did not express any concerns. The department conducted interviews, facility observation and record review to investigate above allegation. During interviews with facility staff and residents, it has been revealed that facility is providing care to residents according to resident’s needs and service plans. During residents’ and staff interviews, it has been concluded that facility has enough staff to meet the needs of the residents in care. During department visits, department observed that residents appeared to be well groomed and in good care, therefore, the above allegation is found to be UNSUBSTANTIATED.

Allegation- Facility staff did not respond to resident's call button.

The department investigated allegation, “Facility staff did not respond to resident’s call button.” The department interviewed staff, administrator, and residents in care. During residents’ interview, residents stated that staff respond to their call buttons in timely manner however sometimes there is a delay in response due to staff assisting other resident’s needs. During staff interviews, staff stated that they always tried their best to answer all residents call buttons as soon as they can, but some residents get upset if they have to wait. During call button log review, department did not observe any long/extended wait time from staff to respond to residents call button, therefore this allegation is UNSUBSTANTIATED.

A finding that the complaint allegations is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No citations were issued today. Exit meeting conducted with administrator.
A copy of this report has been provided to facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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, 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
05/11/2023 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20230511155138

FACILITY NAME:	GOLDEN HILLS CARE HOME		FACILITY NUMBER:	315002894
ADMINISTRATOR:	MAHAJAN, VIVEK		FACILITY TYPE:	740
ADDRESS:	1434 ELM STREET		TELEPHONE:	(916) 474-4920
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95678
CAPACITY:	6	CENSUS: 4	DATE:	06/06/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Vivek Mahajan		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility not accepting resident back into the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Talwinder Bains and Lavinia Muscan arrived at the facility unannounced on 06/06/23 to deliver complaint investigation findings for above allegations. LPAs met with administrator Vivek Mahajan and explained the purpose of the visit.

Allegation-Facility not accepting resident back into the facility.
Department reviewed facility records, conducted interviews with staff and residents and facility’s observation to investigate the complaint allegation. From record review and interviews, it has been found out that R1 got admitted to facility on 04/22/23. R1 was sent to hospital on 05/08/23 after R1 had called 9-1-1 to seek medical care at hospital. Per record review and interviews, it has been concluded that R1 was not satisfied with facility’s services and want high level of care in a skilled nursing setting, therefore, R1 called 9-1-1 on 05/08/23 to go to hospital so doctor can assess R1 and can make appropriate referral based on R1s care needs to place somewhere else. Furthermore, facility was never contacted by hospital after 05/08/23 to accept R1 back to the facility and facility did not refuse to accept R1 back to the facility, this allegation 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. Copy of the report has been provided to facility.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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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