315003016-2-12-2025-59-AS-TORZ-DE4UPD-20250221144522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315003016
Report Date: 02/12/2025
Date Signed: 02/12/2025 03:07:48 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
10/14/2024 and conducted by Evaluator Graham Gunby

COMPLAINT CONTROL NUMBER: 59-AS-20241014103928

FACILITY NAME:	SENIOR CARE VILLA OF LOOMIS		FACILITY NUMBER:	315003016
ADMINISTRATOR:	ILONA CORPUS		FACILITY TYPE:	740
ADDRESS:	3400 CHISOM TRAIL		TELEPHONE:	(916) 652-8000
CITY:	LOOMIS	STATE: CA	ZIP CODE:	95650
CAPACITY:	27	CENSUS: 20	DATE:	02/12/2025
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Executive Director, Ilona Corpus		TIME COMPLETED:	02:43 PM

ALLEGATION(S):

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Staff did not ensure that resident's care needs were met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Graham Gunby arrived unannounced on 02/12/2025 to complete and deliver findings to a complaint received on 10/14/2024. LPA met with Executive Director Ilona Corpus and explained the purpose of the visit.

Throughout the course of the investigation, LPA interviewed the Administrator and staff. LPA reviewed R1’s file including face sheet, physicians report, and care plan. The result of the investigation is as follows:
Based on the investigation, it was determined that staff acted within appropriate care protocols. According to care plans for R1, wound care of this nature must be performed by a licensed skilled professional.

Evidence collected during the investigation, including staff interviews and documentation review, confirmed that staff were instructed not to replace the patch because doing so falls outside their scope of practice. Further, it was confirmed that the licensed staff responsible for wound care were promptly notified to address the issue when it arose.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

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-20241014103928

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: SENIOR CARE VILLA OF LOOMIS	FACILITY NUMBER: 315003016
	VISIT DATE: 02/12/2025

NARRATIVE

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Additionally, the care plan for R1 explicitly notes that wound care must be conducted by qualified personnel. There is no evidence to suggest a delay or neglect in responding to R1’s care needs within the scope of the staff’s responsibilities.

Interviews and record reviews indicated that staff were alerting hospice of any problems relating to the dressing, therefore the above allegations are UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. A copy of this report was emailed to the Executive Director.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC9099 (FAS) - (06/04)

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