317005513-10-26-2023-59-AS-APEZ-CX4L3L-20231030082408

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 317005513
Report Date: 10/26/2023
Date Signed: 10/26/2023 01:33:05 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
10/20/2023 and conducted by Evaluator Sarena Keosavang

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20231020105345

FACILITY NAME:	STERLING COURT AT ROSEVILLE		FACILITY NUMBER:	317005513
ADMINISTRATOR:	DEBRA DUVAL		FACILITY TYPE:	740
ADDRESS:	100 STERLING CT		TELEPHONE:	(916) 786-7200
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95661
CAPACITY:	128	CENSUS: 79	DATE:	10/26/2023
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Executive Director: Debra Duval		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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- Staff did not properly handle residents' information.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 10/26/2023 to deliver final finding for a complaint Community Care Licensing (CCL) received on 10/20/2023. LPA met with Executive Director (ED), Debra Duval, and explained the purpose of the visit.

According to complainant, Health and Wellness Director (HWD) called off duty staff to discuss residents' infromation which may have violated HIPPA. During the complaint investigation, the Department interviewed a total of nine (9) facility staff. Facility staff denies discussing residents' information via telephone with faciity's management. Interview statements received from staff indicated they have no knowledge of the incident.

Continue on LIC9099-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: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

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-20231020105345

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: STERLING COURT AT ROSEVILLE	FACILITY NUMBER: 317005513
	VISIT DATE: 10/26/2023

NARRATIVE

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The Department received interview statement from ED. ED indicated Health and Wellness Director resigned on 10/12/2023. The Department conducted a telephone interview with Health and Wellness Director. Health and Wellness Director denies discussing residents' information with staff via telephone.

Based on the Department’s investigation as stated above, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation 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.

Exit interview conducted and report provided.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC9099 (FAS) - (06/04)

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