342700151-6-2-2022-27-AS-CACL-CF6PLP-20220607112505

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700151
Report Date: 06/02/2022
Date Signed: 06/02/2022 02:21:08 PM

Unsubstantiated

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
05/11/2022 and conducted by Evaluator Avelina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220511153533

FACILITY NAME:	ORANGE GROVE SENIOR LIVING		FACILITY NUMBER:	342700151
ADMINISTRATOR:	VENEGAS, MARICAR MERCADO		FACILITY TYPE:	740
ADDRESS:	228 GRACE AVENUE		TELEPHONE:	(916) 993-9099
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95838
CAPACITY:	6	CENSUS: 6	DATE:	06/02/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Theresa Autencio		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility is unsafe
Facility is unsanitary
Food is not prepared in a healthful manner
Staff did not assist resident with their basic laundry services
Staff speaks inappropriately to residents in care

INVESTIGATION FINDINGS:

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On 06-02-2022 at 12:30 PM, Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced facility visit to deliver complaint findings. LPA Martinez met with Theresa Autencio and explained the purpose of today's visit.

Throughout the course of the investigation, interviews and file reviews were conducted. LPA interviewed four out of 6 residents. Two residents did not want to be interviewed. Four residents reported feeling safe in the facility, and reported the facility was clean and sanitary. LPA Martinez inspected bathrooms, and there were no rug hazards. There is also a designated area for smoking, and residents are supervised when smoking. Additionally, four residents reported the food was good and prepared in a healthful manner. It was also reported by residents that the facility staff was washing their clothes. Moreover, residents reported staff treat them well and have no issues. Due to the above noted information, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, and therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was given to the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

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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