315002908-2-8-2024-59-AS-MSEY-D2GMX3-20240215085913

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002908
Report Date: 02/08/2024
Date Signed: 02/08/2024 02:46:29 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
01/16/2024 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20240116083631

FACILITY NAME:	GRANITE BAY VILLAS I		FACILITY NUMBER:	315002908
ADMINISTRATOR:	KHAN, SHAHBAZ		FACILITY TYPE:	740
ADDRESS:	8342 JOE RODGERS ROAD		TELEPHONE:	(916) 300-6967
CITY:	GRANITE BAY	STATE: CA	ZIP CODE:	95746
CAPACITY:	6	CENSUS: 6	DATE:	02/08/2024
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Caregiver		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Sexual abuse

INVESTIGATION FINDINGS:

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On2/8/24, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations spoke with the Administrator by phone.

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

Resident R1 was seen at an area hospital on 6/23/2023 where bruising was discovered and hospital staff suspected possible sexual abuse. A sexual assault response team (SART) examination was completed and no forensic evidence was found to indicate R1 was sexually assaulted. R1 did not make any disclosures of being sexually assaulted.
Multiple staff denied observing any bruising while R1 was in care.
...
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: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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-20240116083631

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 I	FACILITY NUMBER: 315002908
	VISIT DATE: 02/08/2024

NARRATIVE

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Additionally, R1's Medical Power of Attorney (POA) was inconsistent in her statement regarding when she took R1 to the emergency room for evaluation. Records and statements found that R1 was discharged from Granite Bay Villas I on 6/22/2023 and relocated to another licensed residence. On 6/23/2023, staff at the residence that R1 resided in contacted R1’s POA and reported to the POA that R1 was aggressive and showing signs of confusion. POA took R1 to the emergency room, on 6/23/2023, where the bruising was discovered. R1's medical records corroborate this information. During interviews, staff reported giving R1 a shower the morning of 6/22/2023 before R1 transferred to a new residence and denied seeing any bruising on R1's body.

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.

Report reviewed with administrator and staff signed for receipt. Copy of report provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC9099 (FAS) - (06/04)

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