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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700064
Report Date: 11/26/2025
Date Signed: 11/26/2025 11:18:16 AM

Substantiated


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
11/25/2025 and conducted by Evaluator Kimberly Viarella
COMPLAINT CONTROL NUMBER: 27-AS-20251125172322
FACILITY NAME:GRAMERCY COURTFACILITY NUMBER:
342700064
ADMINISTRATOR:TONI JONESFACILITY TYPE:
740
ADDRESS:2200 GRAMERCY DRIVETELEPHONE:
(916) 482-2200
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:85CENSUS: 84DATE:
11/26/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Joanne Blackburn, Designee / Wellness NurseTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility violated a resident's personal rights by sending their medical information to an unauthorized person.
INVESTIGATION FINDINGS:
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On 11/26/25, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to open a complaint investigation into the above allegation. LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with Designated Facility Administrator/Executive Director (ED). LPA met with Designee / Wellness Nurse, Joanne Blackburn and a brief interview followed.

LPA explained that it was reported to Community Care Licensing that when a responsible party for a resident, (R1) requested a copy of R1's medical file, another resident's (R2) confidential medical information was included within in it. LPA received a copy of that medical documentation for R2. LPA requested to review the medical files for R1 and R2 during today's visit. LPA and the Designee found that R2's medical information from 2023 was misfiled in R1's file.

Based on interviews and a record review, the licensee did not ensure the confidentiality of record contents and made available confidential information which posed an immediate risk to the health and safety or

Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 27-AS-20251125172322
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: GRAMERCY COURT
FACILITY NUMBER: 342700064
VISIT DATE: 11/26/2025
NARRATIVE
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rights to persons in care. This deficiency has been cited on the LIC 9099 D page.

Due to time constraints, this LPA will conduct a walkthrough of the facility during the opening of a complaint investigation which will take place immediately following this visit.

According to the California Code of Regulations, Title 22, no other deficiencies were observed or cited during this visit. A copy of this report was provided along with APPEAL RIGHTS and an exit interview was conducted with Designee Blackburn.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 27-AS-20251125172322
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: GRAMERCY COURT
FACILITY NUMBER: 342700064
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/27/2025
Section Cited
CCR
87506(c)(1)
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(c) All information and records...residents shall be confidential. (1)The licensee shall be responsible ...confidentiality of their contents. The licensee...only upon the resident's written consent or that of his designated representative. The Licensee did not meet the above requirement as evidenced by:
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Designee stated that over the next 24 hours they will conduct a training regarding the importance of maintaining resident confidentiality and appropriately filing all documentation. Signature sheets for those who attend the training will be submitted to Licensing at:

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Based on interviews and record review, the licensee did not ensure the confidentiality of record contents and made available confidential information which poses an immediate Health Safety or Personal Rights risk to persons in care.

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CCLASCPSacramentoSouthRO@dss.ca.gov with a copy to kimberly.viarella@dss.ca.gov.
Designee will also submit an audit of all resident files to ensure that they do not contain any misfiled information. All of the above will be submitted by 11/27/25.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3