342700005-12-4-2024-27-AS-KHOS-DCPPS3-20250107103338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700005
Report Date: 12/04/2024
Date Signed: 12/04/2024 04:21:19 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
10/15/2024 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20241015084008

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: 67	DATE:	12/04/2024
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Irene Charnell		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Licensee does not ensure facility is kept free of pests
Licensee does not ensure staff are in good health to perform assigned tasks
Licensee does not ensure equipment is maintained and in good repair

INVESTIGATION FINDINGS:

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On 12-4-24 at 1:35pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced at facility to deliver and discuss findings for the allegations noted above. LPA met with Executive Director Irene Charnell and explained the purpose of the visit. During this investigation, LPA conducted interviews with six staff members and reviewed facility file documentation including caregiver schedule, employee records, and pest control agreement. Additionally, LPA conducted facility observations on 10/24/2024 and 12/4/2024.

Allegation: Licensee does not ensure facility is kept free of pests. LPA conducted interview and observation as noted above. Observation conducted did not reveal the presence or evidence of pests within the facility. Interviews conducted revealed that although facility has a history of presence of pests, a pest control service is conducted regularly since 4/19/2022 with most recent service conducted 12/4/2024.
{Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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-20241015084008

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: 12/04/2024

NARRATIVE

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LPA observed and reviewed facility’s pest control agreement to confirm the above. As a result, there is not a preponderance of evidence to conclude licensee does not ensure facility is kept free of pests, therefore, this allegation is UNSUBSTANTIATED.

Allegation: Licensee does not ensure staff are in good health to perform assigned tasks. LPA conducted interviews, record reviews, and observation as noted above. Interviews conducted did not reveal staff attempting to perform assigned duties while exhibiting poor health symptoms. Interviews further revealed staff are not being requested to work while ill. LPA’s review of various staff records revealed that staff can physically perform duties and are in adequate health. LPA’s observation revealed staff interacting appropriately with residents in care and able to perform various care techniques appropriately and without physical difficulty. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

Allegation: Licensee does not ensure equipment is maintained and in good repair. LPA conducted interviews and observation as noted above. Interviews conducted revealed no corroborated statement of disrepair items in facility currently or in the recent past. LPA’s observation revealed no disrepair items within facility. LPA observed the proper functionality of devices in kitchen and all four cottages including dishwashers, refrigerators, and lighting fixtures. As a result, there is not a preponderance of evidence to conclude facility’s equipment is in poor condition or disrepair, therefore, this allegation is UNSUBSTANTIATED.

An allegation of unsubstantiated means that the allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with Executive Director and a copy of this report was provided. Appeal rights provided.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC9099 (FAS) - (06/04)

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