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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317000780
Report Date: 03/07/2023
Date Signed: 03/07/2023 10:24:11 AM

Substantiated


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
11/29/2022 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20221129140508
FACILITY NAME:GLADDING RIDGEFACILITY NUMBER:
317000780
ADMINISTRATOR:KRISTINE REYMONTFACILITY TYPE:
740
ADDRESS:1660 THIRD STREETTELEPHONE:
(916) 645-0106
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:99CENSUS: 41DATE:
03/07/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Kristine ReymontTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Facility failed to report incident to family
INVESTIGATION FINDINGS:
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LPA Parks arrived on Tuesday March 7, 2023 to conclude the investigation regarding the following allegation: Facility failed to report incident to family. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

Throughout the course of the investigation, LPA interviewed facility staff including Administrator, Marketing Director, Activities director, and caregivers. LPA reviewed R1’s care plan and charting notes. LPA also interviewed R1’s local POAs. The interviews revealed that R1’s family was not notified that R1 and R2 left community property with staff following. R1’s family was not notified of the event until a later date, when R1’s hospice provider became aware of the incident.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
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 5
Control Number 25-AS-20221129140508
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: GLADDING RIDGE
FACILITY NUMBER: 317000780
VISIT DATE: 03/07/2023
NARRATIVE
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Therefore, the allegation that the facility failed to report an incident to family is SUBSTANTIATED.

As a result of this investigation, LPA finds the allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiencies cited on 9099-D. Appeal rights were printed and given.

Exit interview conducted. A copy of this report was left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 25-AS-20221129140508
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: GLADDING RIDGE
FACILITY NUMBER: 317000780
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/31/2023
Section Cited
CCR
87468.1(a)(8)
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Personal rights
(8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement was not met
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Facility to train all staff regarding reporting requirements to POAs
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as evidenced by R1's POA not being informed of exit seeking behavior including R1 and R2 exiting facility property with staff. This poses a potential threat to the health and safety of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
11/29/2022 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20221129140508

FACILITY NAME:GLADDING RIDGEFACILITY NUMBER:
317000780
ADMINISTRATOR:KRISTINE REYMONTFACILITY TYPE:
740
ADDRESS:1660 THIRD STREETTELEPHONE:
(916) 645-0106
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:99CENSUS: 41DATE:
03/07/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Kristine ReymontTIME COMPLETED:
10:55 AM
ALLEGATION(S):
1
2
3
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8
9
Facility staff failed to provide supervision
INVESTIGATION FINDINGS:
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LPA Parks arrived on Tuesday March 7, 2023 to conclude the investigation regarding the following allegation: Facility staff failed to provide supervision. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

Throughout the course of the investigation, LPA interviewed facility staff including Administrator, Marketing Director, Activities director, and caregivers. LPA reviewed R1’s care plan and charting notes. LPA also interviewed R1’s local POAs. Additionally, LPA interviewed R1’s hospice provider employees who had knowledge of the incident. The interviews revealed that at the end of October, R1 was assisted R2 in helping to locate their car or house off facility property. According to staff present during this event, two staff accompanied R1 and R2 across the street from the facility. All staff interviewed stated that the residents were never alone, nor were they without supervision.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 25-AS-20221129140508
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: GLADDING RIDGE
FACILITY NUMBER: 317000780
VISIT DATE: 03/07/2023
NARRATIVE
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Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegation is 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 left at the facility
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5