340312955-6-30-2021-27-AS-SRIN-C4QQJ4-20210708121207

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 340312955
Report Date: 06/30/2021
Date Signed: 06/30/2021 11:01:12 AM

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
10/07/2020 and conducted by Evaluator Tuyet-Suong Teh

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20201007094843

FACILITY NAME:	CITY CREEK ASSISTED LIVING		FACILITY NUMBER:	340312955
ADMINISTRATOR:	CRUMMIE, BRIDGETTE		FACILITY TYPE:	740
ADDRESS:	6254 66TH AVE.		TELEPHONE:	(916) 393-2324
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	121; 121	CENSUS:	DATE:	06/30/2021
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Kevin Literrer		TIME COMPLETED:	10:57 AM

ALLEGATION(S):

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Staff is Verbally abusive towards residents.
Staff is Sexually abusive towards residents.
Staff force resident to take medications.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Suong Teh and LPA Christina Valerio made subsequent complaint investigation on 06/30/21 to deliver the findings. LPA spoke to the facility administrator Kevin Litterer and Revenue Control Manager Bridgette Crummie to explained the purpose of the visit.
On 10/20/20, The Department interviewed the Reporting Party (RP). RP stated that resident #1 (R1) told her that a janitor at City Creek Assisted Living was having a sexual activity with her. RP stated that R1 said the Janitor was forcing the non-consensual sex with her. RP stated that the Janitor threatened R1 her harm her if she disclosed their sexual activity. RP also stated that R1 told her that Staff #3 (S3) was very mean to R1 and made fun of her husband.
On 10/21/20, The Department interviewed resident #1 (R1). R1 stated that staff #4 (S4) was very kind to her. R1 said that S4 would touch her breasts on many occasions. R1 stated that the sexual abuse started about 3 years ago. R1 stated that they did not have sexual intercourse. According to R1, when her husband was not around, S4 would come in her room and wait for her to come out from the shower. R1 stated that S4 would take her hand to touch his genital. R1 started to cry and said, “I did not want S4 to touch me.” R1 stated that S4 have slept with other women at City Creek. R1 also said that she like S4 like a friend but she loves her husband. R1 said that S4 told her that he cares for her.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tuyet-Suong Teh	TELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

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 27-AS-20201007094843

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: CITY CREEK ASSISTED LIVING	FACILITY NUMBER: 340312955
	VISIT DATE: 06/30/2021

NARRATIVE

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R1 said that S4 has threaten to harm her if she tells anyone about their sexual relationship. R1 stated that Staff 3 (S3)was mean to her. R1 stated that S3 told her that her husband was not able to perform sexual activity. R1 disclosed to S3 that she wanted to kill herself. According to R1, S3 told her that she did not have the guts to do it.

On 11/02/2020 and 11/06/2020, The Department interviewed staff #4 (S4). S4 confirmed that he knew R1. S4 stated that R1 one day can be normal and the other day she would cuss him out. S4 said he never had a problem with R1’s husband, who lived in the same room as R1. S4 stated to work at City Creek for approximately two years. S4 stated that he does not assist in showering or helping residents use the bathroom. S4 stated that he never assisted residents with dressing. S4 confirmed that he never assisted R1 with dressing. S4 confirmed that his job did not require him to physically assist residents.

On 06/22/21 The Department interviewed staff #1 (S1). S1 recalled R1 was very demanding and wanted lots of attention. S1 stated that R1 could be likable one day and calling people names the next day. S1 recalled one incident sometime in 2020, R1 left the facility and was brought by the Sacramento Sheriff. S1 recalled speaking to R1 about leaving the facility while they were in the pandemic. S1 stated that R1 stated that no one loves her and all she wanted to go the library.

On 06/22/21 The Department interviewed staff #2(S2). S2 confirmed that R1 did elope from the facility on September 15, 2020 and was brought back by the Sacramento Sheriff. S2 stated that R1 was very demanding and if she did not get the attention, R1 would yell and used racial slurs. S2 confirmed that R1 refused to stay in the room while in lock down.

On 06/28/21, LPA called and spoke to staff #3 (S3). S3 confirmed to remember R1. S3 stated that R1 was nice one day and rancid the next. S3 stated that when R1 had her melt down, R1 was verbally abusive to her. S3 stated that R1 used racial slurs toward her. S3 stated that R1 was somewhat compliance with her medications but only refused her medications when she had her meltdown.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tuyet-Suong Teh	TELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20201007094843

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: CITY CREEK ASSISTED LIVING	FACILITY NUMBER: 340312955
	VISIT DATE: 06/30/2021

NARRATIVE

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On 06/29/21, The Department interviewed staff #5 (S5). S5 confirmed that she remembered R1. S5 stated that R1 could be in a good mood and in a split of a second she would have a meltdown and started to yell at the staff. S5 stated that R1 would make sexual comments about the facility maintenance man (FMM). According to S3, R1 told her that she liked and wanted FMM as her boyfriend. S5 stated that R1 asked S5 not tell her husband. Regarding the electronic medical administration record (EMAR) chart dated 09/18/2020 "Physically unable to take," means that S5 attempted to get R1’s vitals but she stated that the machine squeezed her arms too tight and she was uncomfortable. Therefore, S5 did not pursue further and logged as "Physically unable to take."

On 11/02/20, The Department reviewed R1’s Medication Administration Record (MAR) in August 2020 and September 2020 on several occasion the MAR reported as “physically unable to take,” and “Out of the Facility.”

Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is unsubstantiated. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tuyet-Suong Teh	TELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

LIC9099 (FAS) - (06/04)

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