342700018-6-26-2024-27-AS-SRIN-D7GP4H-20240724105911

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700018
Report Date: 06/26/2024
Date Signed: 06/26/2024 05:29:26 PM

Unfounded

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
06/19/2024 and conducted by Evaluator Victoria Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240619141108

FACILITY NAME:	GROVE HOME CARE		FACILITY NUMBER:	342700018
ADMINISTRATOR:	BOBOC, LUCIA		FACILITY TYPE:	740
ADDRESS:	8410 TERRACOTTA CIRCLE		TELEPHONE:	(916) 225-6405
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95624
CAPACITY:	6	CENSUS: 6	DATE:	06/26/2024
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Lucia Boboc		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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9

Licensee did not ensure resident's medication was administered by an appropriately skilled professional.
Staff do not ensure that the facility is free of pests.

INVESTIGATION FINDINGS:

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5
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 6/26/24 at 4pm to conduct an investigation of the above-mentioned allegations. LPA met with Administrator Lucia Boboc and stated the purpose of the visit. LPA conducted interviews of residents 1-5 and staff 1-4, and the Hospice Representative during this visit. Regarding allegation, “Licensee did not ensure resident's medication was administered by an appropriately skilled professional” LPA conducted interviews of staff, residents, and hospice agency on 6/26/24. The investigation revealed that staff was not asssiting with administering morphine to R1. However, family of R1 was trained to do so. Regarding allegation, "Staff do not ensure that the facility is free of pests", LPA conducted a physical plant tour of the facility observing furniture, drawers, kitchen, and bedrooms. LPA did not observe insects in the home nor evidence of feces or droppings. Based on observation and interviews, at this time, the allegations are deemed UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint. Per California Code of Regulations (CCRs) - Title 22, Div.6, Ch. 8, no deficiencies are being cited. An exit interview was conducted, and a copy given.

Unfounded

Estimated Days of Completion: 30

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

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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