342700005-5-9-2024-27-AS-KHOS-D5XGSM-20240605053606

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700005
Report Date: 05/09/2024
Date Signed: 05/09/2024 03:07:27 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
04/02/2024 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20240402081017

FACILITY NAME:	REVERE COURT		FACILITY NUMBER:	342700005
ADMINISTRATOR:	IRENE CHARNELL		FACILITY TYPE:	740
ADDRESS:	7707 RUSH RIVER DRIVE		TELEPHONE:	(916) 392-3510
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95831
CAPACITY:	72	CENSUS: 69	DATE:	05/09/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Irene Charnell		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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1) Staff did not prevent resident from pushing another resident in care.
2) Resident in care was locked out of the facility.
3) Staff did not follow proper reporting requirements.
4) Staff did not prevent resident from having an indecent exposure incident at the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to the Revere Court RCFE on 5/9/24 at 1:30pm to conclude the investigation of the above allegations and to deliver the findings. LPA Gould met with Administrator, Irene Charnell and together discussed the investigation details.

Based on the interviews and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. LPA Gould conducted interviews with five (5) staff members and three (3) residents in building 1. Per the staff interviews, LPA could not corroborate that an altercation occurred between R2 and R3. Both residents interviewed could not recall or describe the alleged incident. Per R2, she has had only one fall at the facility and it occurred in the bathroom when sick. R2 could not recall if staff were aware of this fall. LPA was unable to corroborate the fall as a result of one resident pushing another. All staff interviewed denied any knowledge of the described incident. The allegations that staff did not prevent a resident from pushing another resident and not reporting the incident are both determined to be unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

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-20240402081017

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: REVERE COURT	FACILITY NUMBER: 342700005
	VISIT DATE: 05/09/2024

NARRATIVE

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Additionally, in regards to alleged indecent exposure allegation and resident being locked out of facility, LPA again conducted 5 staff interviews and three residents interviews. No residents interviewed could recall such an incident and staff denied ever witnessing a resident expose themselves to other residents. LPA also interviewed staff and residents regarding being locked out of the facility. Facility staff did provide statements that while the facility had a COVID outbreak, individual units were locked to prevent residents from going to other cottages and spreading disease. Facility staff also explained different procedures for visitors and residents to gain access to locations during COVID outbreaks. No residents interviewed could corroborate being locked outside the facility.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of neglect/lack of supervision and reporting requirements are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies is cited per California Code of Regulations, TITLE 22.

Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

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