342700197-2-4-2025-27-AS-CACL-DDU49L-20250212175430

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700197
Report Date: 02/04/2025
Date Signed: 02/04/2025 10:11:09 AM

Unsubstantiated

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
11/26/2024 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20241126140608

FACILITY NAME:	CAMELOT CARE BUCKS HARBOR		FACILITY NUMBER:	342700197
ADMINISTRATOR:	CANTILLER, ARACELI		FACILITY TYPE:	740
ADDRESS:	8006 BUCKS HARBOR WAY		TELEPHONE:	(916) 659-5491
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY:	6	CENSUS: 6	DATE:	02/04/2025
		UNANNOUNCED	TIME BEGAN:	08:36 AM
MET WITH:	Janelyn Aragon		TIME COMPLETED:	10:21 AM

ALLEGATION(S):

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The facility does not have enough staff to meet resident needs.
Facility does not have appropriate staff available to assist in an emergency
Housekeeping is not completed on a regular basis.
Staff do not follow infection control.

INVESTIGATION FINDINGS:

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On 02/04/25 at 8:36 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with direct care staff Janelyn Aragon and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 6. A brief interview with conducted with administrator Araceli Cantiller.

It was alleged that the facility does not having enough staff to meet residents’ needs and that the facility does not have appropriate staff to assist residents in an emergency. The investigation involved reviewing records, interviewing staff, residents, and 2 regular visitors, as well as observations. According to the facility’s LIC 500 Personnel Records, from Monday to Thursday, there are three staff members on-site from 7:00 AM to 12:00 PM, and two staff members from 12:00 PM to 7:00 AM. On Fridays through Sundays, there are two staff members from 7:00 AM to 7:00 PM. The facility’s LIC 610D Emergency Disaster Plan outlines protocols for emergencies.
Continued LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

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 27-AS-20241126140608

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: CAMELOT CARE BUCKS HARBOR	FACILITY NUMBER: 342700197
	VISIT DATE: 02/04/2025

NARRATIVE

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LPA Lee interviewed 4 out of 5 residents who expressed no concerns about regarding staffing and during emergencies. Additionally, all three facility staff members denied the allegation, affirming that they assist residents with activities of daily living (ADLs) and any other needs, and they believe the staffing level is sufficient for emergencies. Furthermore, 3 regular visitors to the facility reported no concerns about staffing and confirmed seeing three staff members on-site. On 01/15/25, LPA Lee observed three staff members from 8:30 AM to 12:00 PM and two staff members from 12:00 PM to 3:55 PM. Based on interviews and statements gathered throughout the investigation, LPA Lee was unable to corroborate the allegations.

It was alleged that the facility housekeeping is not completed on a regular basis. The investigation involved reviewing records, interviewing staff, residents, and three regular visitors, as well as observations. Facility record showed that the facility has a cleaning schedule in place. In interviews with residents, 4 out of 5 residents stated they had no concerns about housekeeping and that their rooms are cleaned by the care staff. Additionally, 3 regular visitors reported that the facility appeared clean and expressed no concerns. On 01/15/25, LPA Lee toured the facility, inspecting residents' bedrooms, bathrooms, and all areas used by residents. All areas were observed to be clean, sanitary, and comfortable. The facility appeared well maintained, with no concerns noted during the visit and today’s visit. Based on the interviews and observations made during the investigation, LPA Lee was unable to corroborate the allegations.

It was alleged that the facility is not following infection control. The investigation included a review of records, interviews with staff, residents, and three regular visitors, as well as observations. Facility records showed that the facility has infection control measures in place. In interviews with residents, 4 out of 5 resident stated that care staff wear gloves when assisting them with care and expressed no concerns, denying the allegations. 3 facility staff members were initially unable to explain the term "hygiene" until LPA Lee provided examples. Once clarified, staff confirmed that they wash their hands before and after assisting with incontinence care and wear gloves during this process. It was unclear if a language barrier contributed to the confusion. 2 regular visitors reported no concerns regarding infection control and stated that they have not witnessed any issues with the facility’s practices. On 01/15/25, during a facility visit, LPA Lee observed staff (S1) assisting resident (R1) with a transfer while wearing gloves, and then washing hands afterward. Based on the interviews and observations made throughout the investigation, LPA Lee was unable to corroborate the allegations.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred. An exit interview was conducted and a copy of this LIC 9099, report was provided to facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

LIC9099 (FAS) - (06/04)

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