315002907-8-15-2023-59-AS-MSEY-CURU36-20230816151300

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002907
Report Date: 08/15/2023
Date Signed: 08/15/2023 02:37:52 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, 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
07/03/2023 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230703150442

FACILITY NAME:	GRANITE BAY VILLAS II		FACILITY NUMBER:	315002907
ADMINISTRATOR:	KHAN, SHAHBAZ		FACILITY TYPE:	740
ADDRESS:	8352 JOE RODGERS ROAD		TELEPHONE:	(916) 300-6967
CITY:	GRANITE BAY	STATE: CA	ZIP CODE:	95746
CAPACITY:	6	CENSUS: 3	DATE:	08/15/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jo Schiavo		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility not notifying POA when resident fell

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on August 15, 2023, to complete and deliver findings for a complaint received on 7/3/2023. LPA met Jo Schiavo, House Manager, and explained the purpose of the visit.

Throughout the course of investigation, LPA reviewed R1’s file. LPA interviewed staff regarding protocol of informing POAs when residents have a fall or change of condition. LPA learned that R1 had poor vision. Staff would assist R1 with activities of daily living including bathing, dressing, grooming, and incontinence care. LPA learned that R1 had several falls while living at the facility. Staff interviewed stated that the Administrator was made aware of the falls. The Administrator stated that the POA was notified after each fall. Based on information obtained during the investigation, LPA finds the allegation to be 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 evidence to prove that the alleged violation occurred,

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

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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 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
07/03/2023 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230703150442

FACILITY NAME:	GRANITE BAY VILLAS II		FACILITY NUMBER:	315002907
ADMINISTRATOR:	KHAN, SHAHBAZ		FACILITY TYPE:	740
ADDRESS:	8352 JOE RODGERS ROAD		TELEPHONE:	(916) 300-6967
CITY:	GRANITE BAY	STATE: CA	ZIP CODE:	95746
CAPACITY:	6	CENSUS: 3	DATE:	08/15/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jo Schiavo		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility overcharging resident
Resident's served food of poor quality
Facility charging late fee

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on August 15, 2023, to complete and deliver findings for a complaint received on 7/3/2023. LPA met with Jo Schiavo, House Manager, and explained the purpose of the visit.

Throughout the course of investigation, LPA interviewed staff and residents. LPA observed refrigerator and pantry foods for this facility and Granite Bay Villas I (next door). LPA reviewed weekly food menu and obtained documentation of meals previously served. Based on interviews, documentation reviewed, and observation, LPA finds that the facility services a variety of quality meals to the residents. Additionally, residents can ask for an alternative meal to the one being served.

LPA reviewed R1 and R2’s facility file. LPA reviewed admission agreements which show that R1 moved into the facility initially with their spouse (R2). Both R1 and R2 lived in the same room. When R2 passed away, R1 was moved into a private room. At that time, a new admission agreement was signed for R1.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 59-AS-20230703150442

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: GRANITE BAY VILLAS II	FACILITY NUMBER: 315002907
	VISIT DATE: 08/15/2023

NARRATIVE

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Based on review of documentation, LPA finds that the facility was billing the agreed upon rate. Additionally, at the time of the complaint being filed, R1’s rent for May and June 2023 was not paid. LPA determined that the facility was charging the late fee rate established in the signed admission agreement.

Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegations are found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. A copy of this report was provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3