342700064-9-16-2024-27-AS-KHOS-DCPSQT-20250107130517

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700064
Report Date: 09/16/2024
Date Signed: 09/16/2024 01:30:37 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
09/04/2024 and conducted by Evaluator Christina Valerio

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240904110359

FACILITY NAME:	GRAMERCY COURT		FACILITY NUMBER:	342700064
ADMINISTRATOR:	VERONICA MORALES		FACILITY TYPE:	740
ADDRESS:	2200 GRAMERCY DRIVE		TELEPHONE:	(916) 482-2200
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	85	CENSUS: 81	DATE:	09/16/2024
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Veronica Morales		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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2
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9

Staff neglect resulted in resident sustaining serious bodily injury
Staff neglect resulted in resident sustaining an unwitnessed fall

INVESTIGATION FINDINGS:

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9
10
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to deliver complaint findings. LPA Valerio met with Administrator , and explained the purpose of the visit.

On 09/05/2024, The Regional Office conducted an unannounced visit and learned Resident 1 (R1) was not a resident of the facility. On 09/05/2024, LPA Moleski could not acquire documentation regarding a resident (R1) as they are a resident of a skilled nursing facility, which is outside the jurisdiction of the Community Care Licensing Division. On 09/06/2024, complaint information was cross reported to the Department of Public Health. Based on the above noted information, the allegations are deemed Unfounded. The allegation is 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 (CCR) - Title 22, no deficiencies were observed or cited. An exit interview was held, and a copy of the report was provided.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

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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