342700157-4-19-2023-25-AS-LMUZ-CR4Q6M-20230421115347

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700157
Report Date: 04/19/2023
Date Signed: 04/19/2023 10:26:04 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
01/30/2023 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 25-AS-20230130160250

FACILITY NAME:	CHALET, THE		FACILITY NUMBER:	342700157
ADMINISTRATOR:	PATEL, NISHA		FACILITY TYPE:	740
ADDRESS:	6487 MAIN STREET		TELEPHONE:	(925) 787-2740
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	41	CENSUS: 22	DATE:	04/19/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Staff, Elsa Ruiz		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff do not respond to resident's request for assistance in a timely manner.
Staff threaten resident.
Resident does not have adequate meal service.
Staff does not administer resident's medication as prescribed.

INVESTIGATION FINDINGS:

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On 04/19/2023, LPA Bains came to the facility to deliver complaint findings. LPA was screened upon entry including temparature. Around 10am, LPA spoke to administrator, Maria Susie Dizon via phone and and explained the purpose of the visit. Administrator gave permission to meet with staff-Elsa Dizon regarding today's visit since she was unable to come.

Throughout the course of the investigation the department reviewed documentation and conducted interviews relevant to the complaint allegations.

Report continued on LIC 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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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Control Number 25-AS-20230130160250

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: CHALET, THE	FACILITY NUMBER: 342700157
	VISIT DATE: 04/19/2023

NARRATIVE

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*****continued from LIC9099............

Allegation--Staff do not respond to resident's request for assistance in a timely manner. -UNFOUNDED
The department conducted interviews, facility observation and record review to investigate above allegation. During interviews with facility staff and residents on 02/07/23, it has been discovered that facility is meeting resident activities of daily living (ADLs) needs based on resident’s needs and service plans. During residents’ interviews, residents stated that their care needs have been met by staff and did not express any issues or concerns. A review of staffing records indicated the facility did provide all required staffing and assistance to meet residents care needs. During department visit on 02/07/23, department observed that residents appeared to be well groomed and in good care, therefore this allegation is UNFOUNDED.

Allegation--- Staff threaten resident. ---UNFOUNDED

LPA Bains interviewed 3 staff and 3 residents during complaint investigation on 02/07/23. Department conducted the investigation for the stated allegation from this complaint. Department conducted a tour of the facility on 02/07/23 and conducted interviews with administrator, residents, staff. Interviews did not indicate any residents, staff and/or witness observed that staff are threatening any residents in care. Department observed while doing facility tour on 02/07/23 that facility staff appeared to be attentive to resident’s needs and treating residents with dignity and respect. During residents’ interviews, residents stated that facility staff is treating all residents with respect and dignity. Based on facility tour, interviews and observation, department found out that there is no evidence that resident (s) are being threaten by facility staff, therefore this allegation is found to be UNFOUNDED.

Report continued on LIC 9099-C..........

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20230130160250

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: CHALET, THE	FACILITY NUMBER: 342700157
	VISIT DATE: 04/19/2023

NARRATIVE

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*****continued from LIC9099............

Allegation---- Resident does not have adequate meal service. ---UNFOUNDED

Department reviewed facility records, conducted interviews with staff and residents and facility’s observation to investigate the complaint allegation. On 02/07/23, Department interviewed 3 residents and 3 staff members and found out that facility was serving good quality foods with different food choices to all residents and there were no issues. Record review indicated that facility has 1-week menu in advance for all residents and residents can choose what they willing to eat. During course of investigation on 02/07/23, department observed that menu was posted in the common area for all residents. Based on all this information, this allegation is UNFOUNDED.

Allegation---- Staff does not administer resident's medication as prescribed. ---UNFOUNDED

Department conducted facility observations, record review and interviews to investigate this complaint allegation. During interviews, it has been revealed that facility did dispense all resident’s medications on time and been administered on time. From record review from 01/01/23 to 01/31/23 for all residents, it has been discovered that facility kept proper log for all medications in centrally stored medication log per physician’s orders without any error. Additionally, during residents’ interviews on 02/07/23, residents expressed no issues with medications administration. Based on this information, this allegation is UNFOUNDED.

Based on records reviewed, facility observations and interviews, all the above allegations are found to be UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

A copy of this report has been provided to facility. No citations have been issued during today's visit.

Exit interview conducted.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC9099 (FAS) - (06/04)

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