342700064-6-22-2023-27-AS-LKIG-CTQTK6-20230714144724

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700064
Report Date: 06/22/2023
Date Signed: 06/22/2023 01:59:16 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
05/19/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20230519101522

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: 77	DATE:	06/22/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Kendra Noonan		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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9

Residents sustained injuries while in care
Due to lack of staffing residents sustain falls while in care
Staff failed to meet residents' needs

INVESTIGATION FINDINGS:

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On 6-22-23 at 9:54am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegations noted above. LPA met with Administrator Kendra Noonan and explained the purpose of the visit. During this investigation, LPA conducted interview with previous Administrator in charge and reviewed facility file documentation for resident1 (R1) and R2. LPA also reviewed facility’s resident roster list. Based on interview and record review, it was determined that R1 and R2 are not and have not been residents of this facility, and do not have additional records to indicate previous residency of this facility.

As a result of this investigation, the preponderance of evidence standard is not met, and these allegations are UNFOUNDED. An exit interview was conducted Staff3 (S3). Administrator Kendra Noonan gave permission for S3 to sign in her absence at the time this report was delivered. A copy of this report was provided to S3.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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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