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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 340300522
Report Date: 01/23/2023
Date Signed: 01/23/2023 10:42:26 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/13/2023 and conducted by Evaluator Tung Truong
COMPLAINT CONTROL NUMBER: 27-AS-20230113121639
FACILITY NAME:PIONEER HOUSEFACILITY NUMBER:
340300522
ADMINISTRATOR:FRAZIER, KAYLAFACILITY TYPE:
740
ADDRESS:415 P STREETTELEPHONE:
(916) 442-4906
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:41CENSUS: 8DATE:
01/23/2023
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Kayla Frazier, AdministratorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility failed to meet resident's medical needs
Resident is not adequately fed at facility
Resident lost severe weight while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tung Truong conducted an unannounced initial complaint visit to the facility on 1/23/2023. LPA met with Administrator Kayla Frazier and explained the purpose of today’s visit.

During today's visit, LPA conducted interviews with the Administrator and resident (R1). LPA received copies of the Assisted Living Resident Roster, the Independent Resident Roster, and Skilled Nursing Resident Roster.

Based on the documentation and interviews, it was revealed that resident R1 is an independent resident that lives on the independent side of the facility not licensed by Community Care Licensing. Since Community Care Licensing has no jurisdiction over independent residents, the allegations are unfounded.

Continued on 9099-C
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
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 2
Control Number 27-AS-20230113121639
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: PIONEER HOUSE
FACILITY NUMBER: 340300522
VISIT DATE: 01/23/2023
NARRATIVE
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As a result of this investigation, the Department finds the allegations above to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint.

Exit interview was conducted with Kayla Frazier and a copy of the report was provided.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2