342700005-12-31-2024-27-AS-KHOS-DCPPS2-20250107103337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700005
Report Date: 12/31/2024
Date Signed: 12/31/2024 02:40:56 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: 64	DATE:	12/31/2024
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Irene Charnell		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff do not ensure residents are spoken to in an appropriate manner
Staff do not ensure residents are handled in an appropriate manner

INVESTIGATION FINDINGS:

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On 12-31-2024 at 1:50pm, 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, three additional witnesses, and reviewed facility file documentation including caregiver schedule, and employee records. Additionally, LPA conducted facility observations on 10/24/2024 and 12/4/2024.

Allegation: Staff do not ensure residents are spoken to in an appropriate manner. LPA conducted interviews and observation as noted above. Based on interviews and observation conducted, it was determined that facility is exclusive to memory care. Interviews did not reveal any corroborated statements of staff speaking inappropriately to residents in care. Observations were conducted by LPA in all four cottages serving memory care residents and consisted of various residents in rooms, common areas, and during activity events.

{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: 12/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024

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: 12/31/2024

NARRATIVE

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LPA’s observations did not reveal staff speaking to residents in an inappropriate manner. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

Allegation: Staff do not ensure residents are handled in an appropriate manner. LPA conducted interviews and observation as noted above. Interviews conducted did not reveal any corroborated statements of staff inappropriately handling residents physically. Observations were conducted by LPA in all four cottages serving memory care residents and consisted of various residents in rooms, common areas, and during activity events. LPA’s observations did not reveal staff physically handling residents in an inappropriate manner. LPA did not observe rough handling in care techniques or redirection attempts. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

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: 12/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024

LIC9099 (FAS) - (06/04)

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