342700005-10-15-2021-27-AS-SRIN-C7YKX6-20211020081702

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700005
Report Date: 10/15/2021
Date Signed: 10/15/2021 04:56:07 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
05/11/2021 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20210511112140

FACILITY NAME:	REVERE COURT		FACILITY NUMBER:	342700005
ADMINISTRATOR:	CHAPPELL, BRENDA		FACILITY TYPE:	740
ADDRESS:	7707 RUSH RIVER DRIVE		TELEPHONE:	(916) 392-3510
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95831
CAPACITY:	72	CENSUS: 71	DATE:	10/15/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Brenda Chappell		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident not allowed to have visitors
Resident not allowed to have contact with people via phone.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conclude the investigation of the above mentioned allegations on 10/15/21 at 2:00pm. LPA met with Brenda Chappell and stated the purpose of the visit.

Regarding allegation, "Resident not allowed to have visitors" LPA received the visitation protocol which indicates an update in accordance with the new guidelines from CDSS. During interviews with staff, LPA obtained information that visitation protocols were given to the responsible parties (RP) and any others requested by the (RP) via email. In addition, copies were readily available to visitors upon entry to the facility as stated in the Provider Information Notices (PIN)s. In this case, the protocols were handed to the family. Upon arrival during the visits, the family would not wear masks properly which puts the community residents at risk. Family was reminded of the proper way to wear the masks during the visits. LPA reviewed the Resident Off Campus Register and the Visitor Sign-In/Out Sheet 2021 which indicates that R1 was receiveing visition from several people during the months of April through Sept 30, 2021. The documentations show the names, date, time of entry and exit for those who visited R1.

Unfounded

Estimated Days of Completion: 120

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

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-20210511112140

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: REVERE COURT	FACILITY NUMBER: 342700005
	VISIT DATE: 10/15/2021

NARRATIVE

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Regarding allegation, "Resident not allowed to have contact with people via phone", LPA obtained information through interviews of staff (S1-S3) and the Administrator that R1 was allowed and used the facility phone that was provided to all the residents. R1 used the phone for extended periods of time. The facility requested that consideration be given to the others who needed to use the phone. The family purchased a personal phone for R1 to use at R1 discretion.

Based on interviews and documentation, the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be UNFOUNDED.

“This agency has investigated the complaint alleging, the above-mentioned allegation(s). We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.”

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were cited during this visit. An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

LIC9099 (FAS) - (06/04)

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