315002994-1-30-2024-59-AS-KHOS-D27M2N-20240206081348

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002994
Report Date: 01/30/2024
Date Signed: 01/30/2024 03:03:37 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, 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
01/18/2024 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 59-AS-20240118165138

FACILITY NAME:	BLUE OAKS SENIOR CARE		FACILITY NUMBER:	315002994
ADMINISTRATOR:	ALDEA, SABRINA		FACILITY TYPE:	740
ADDRESS:	4065 PEABODY WAY		TELEPHONE:	(916) 617-8834
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	6	CENSUS: 4	DATE:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Sabrina Aldea, Administrator		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Staff did not provide 60-day notice for rent increase

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings. LPA met with Sabrina Aldea during today’s inspection.
LPA investigated allegation, “Staff did not provide 60-day notice for rent increase.” LPA reviewed resident documents and conducted interviews. LPA found that
administrator/licensee provided R1’s responsible party with a 2 day notice of rate increase due to an increase in care needs. Administrator stated resident has had a change of condition and now requires a 2-person transfer and continence care. LPA reviewed R1's admission agreement, LIC602, old and updated needs and service plan, and the increase notice. LPA observed administrator provided responsible party with the proper notice of increase. Due to the information gathered, LPA finds allegation to be UNFOUNDED.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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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