317005227-9-29-2021-25-AS-LMUZ-C7DQBM-20211001120147

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 317005227
Report Date: 09/29/2021
Date Signed: 09/29/2021 10:01:28 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/29/2021 and conducted by Evaluator Sarena Keosavang

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210729170418

FACILITY NAME:	PAR PLACE SENIOR LIVING		FACILITY NUMBER:	317005227
ADMINISTRATOR:	SANCHEZ, GERALDINE		FACILITY TYPE:	740
ADDRESS:	2407 PAR PLACE		TELEPHONE:	(916) 624-2985
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95677
CAPACITY:	6	CENSUS: 6	DATE:	09/29/2021
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Geraldine Sanchez		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

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- Staff had inappropriate sexual interaction with resident.
- Staff made inappropriate comments to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 09/29/2021 to deliver a complaint finding for a complaint Community Care Licensing (CCL) received on 07/29/2021. LPA met with Licensee, Geraldine Sanchez, and explained the purpose of the visit. Prior to initiating 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 and contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility.

Throughout the course of the complaint investigation the Department conducted interviews and obtained pertinent documents relevant to the allegation: staff had inappropriate sexual intention with resident and staff made inappropriate comments to resident.

*************** Contintue on page LIC 9099-C *******************

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

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 25-AS-20210729170418

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: PAR PLACE SENIOR LIVING	FACILITY NUMBER: 317005227
	VISIT DATE: 09/29/2021

NARRATIVE

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The Department had requested for a copy of the police report filed with Rocklin Police Department for review. The Department also reviewed pertinent documents such as Unusual Incident/Injury Report LIC 624, Report of Suspected Dependent Adult/Elder Abuse SOC 341, and resident’s (R1) Physician’s Report LIC 624, Appraisal/ Needs and Services Plan, and R1’s medical records. The Department interviewed a total of six (6) facility staff (S) members, attempted to interview two (2) residents, and R1’s Responsible Party. During the complaint investigation the Department discovered no staff were present or a direct witness to the alleged incident. No staff reported any concerns or disclosures made to staff regarding the allegations.

This agency has investigated the above listed allegations. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred therefore, we have found the allegations to be UNSUBSTANTIATED.

An exit interview conducted, and a copy of the report is left at the facility.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC9099 (FAS) - (06/04)

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