340312629-10-2-2020-27-AS-MSEY-BUBLE5-20201012084054

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 340312629
Report Date: 10/02/2020
Date Signed: 10/02/2020 04:03:59 PM

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
08/11/2020 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 27-AS-20200811135251

FACILITY NAME:	NAVARRO RESIDENTIAL CARE		FACILITY NUMBER:	340312629
ADMINISTRATOR:	NAVARRO, ANGEL		FACILITY TYPE:	740
ADDRESS:	7327 SOVEREIGN COURT		TELEPHONE:	(916) 721-0452
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	6	CENSUS: 3	DATE:	10/02/2020
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Lito Navarro		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Resident wrongfully evicted

INVESTIGATION FINDINGS:

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On 10/2/20, Licensing Program Analyst (LPA) Kevin Mknelly spoke to Lito Navarro, Administrator of facility Navarro Residential Care – 340312629 at approximately 3:30 PM.
LPA was unable to meet at the facility due to current circumstances.

LPA reviewed documents and conducted interviews.
Records of a summary of R1’s illness progression and care, provided by the licensee, were reviewed and indicate that R1 began to experience changes to their health status and eventually required a higher level of care for their healthcare needs.
A resident’s re-appraisal was completed was completed. It was determined by the client’s public guardian that R1 would be moved from this facility based on a need for higher level of care. On 4/17/20, the Licensee was notified, by the public guardian, that

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2020

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 27-AS-20200811135251

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: NAVARRO RESIDENTIAL CARE	FACILITY NUMBER: 340312629
	VISIT DATE: 10/02/2020

NARRATIVE

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the client would not be returning to the facility after having received post-operative skilled nursing care.
The client’s belongings were removed from the facility on 4/20/20 and fees due to the client were reimbursed. The resident transferred, at the guardian’s request, to a facility equipped to provide a higher level of care to the client.
LPA finds that facility met Tittle 22 requirements.
LPA finds that the resident was not wrongfully evicted.

This agency has investigated the complaint alleging that wrongful eviction. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

Unable to obtain signature. Signature present on hard copy in file. LPA sent a copy of report for Administrator to sign. Administrator to send a signed copy back to CCL.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2020

LIC9099 (FAS) - (06/04)

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