342700064-12-9-2022-27-AS-KHOS-CM5VU8-20221215154420

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700064
Report Date: 12/09/2022
Date Signed: 12/09/2022 03:09:24 PM

Unfounded

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
12/05/2022 and conducted by Evaluator Christopher Hopkins-Clarke

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20221205152831

FACILITY NAME:	GRAMERCY COURT		FACILITY NUMBER:	342700064
ADMINISTRATOR:	CYSEWSKI, TRISA		FACILITY TYPE:	740
ADDRESS:	2200 GRAMERCY DRIVE		TELEPHONE:	(916) 482-2200
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	85	CENSUS: 66	DATE:	12/09/2022
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Trisa Cysewski		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Facility staff does not maintain a comfortable temperature for resident at the facility.
-Facility staff are not properly dispensing resident their medications.
-Facility staff used inappropriate language toward resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 12/9/22 at 2:30 PM, Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced facility visit in regards to a complaint investigation with the above allegations. LPA met with Administrator Trisa Cysewski and stated the purpose of this visit.

Regarding these allegations, LPA spoke to Administrator who stated that Resident 1 (R1) has never lived in Assisted Living, R1 is in Skilled Nursing. CCLD has no jurisdiction over Skilled Nursing, therefore based on the investigation conducted the allegations are UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was provided to facility.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

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 1