342700202-6-24-2020-27-AS-LMUZ-BR2SWK-20200629141429

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700202
Report Date: 06/24/2020
Date Signed: 06/24/2020 01:10:39 PM

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
03/06/2020 and conducted by Evaluator Danyle Wolter

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200306104356

FACILITY NAME:	VILLAGE AT HERITAGE PARK, THE		FACILITY NUMBER:	342700202
ADMINISTRATOR:	BRIGITTE LOESCH		FACILITY TYPE:	740
ADDRESS:	2001 ROSE ARBOR DRIVE		TELEPHONE:	(916) 216-8958
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95835
CAPACITY:	108	CENSUS:	DATE:	06/24/2020
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Melisa Tiburcio, Executive Director		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Insufficient staffing

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wolter contacted the facility on 6/24/2020 to deliver complaint findings via telephone due to COVID-19 and pre-cautionary measures, LPA spoke with Executive Director (ED) Melisa Tiburcio and explained the purpose of the call.
Throughout the course of the investigation LPA reviewed staff schedules, four (4) residents records and charting notes, as well as conducted interviews regarding the allegation: insufficient staffing. Interviews with staff revealed that residents’ needs are generally met, however there were times when residents may have been left alone in the memory care dining room, and that when there are staff call outs it is difficult to always respond “timely” to residents needs. Due to this information the department finds the allegation to be UNSUBSTANTIATED - A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Exit interview conducted. Copy of report sent to ED via e-mail, LPA requests that ED prints out report, signs it, and faxes and/or emails a signed copy to Community Care Licensing. A signed copy should also be retained for facility's records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Danyle Wolter	TELEPHONE: (916) 708-5307
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2020

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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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
03/06/2020 and conducted by Evaluator Danyle Wolter

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200306104356

FACILITY NAME:	VILLAGE AT HERITAGE PARK, THE		FACILITY NUMBER:	342700202
ADMINISTRATOR:	BRIGITTE LOESCH		FACILITY TYPE:	740
ADDRESS:	2001 ROSE ARBOR DRIVE		TELEPHONE:	(916) 216-8958
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95835
CAPACITY:	108	CENSUS:	DATE:	06/24/2020
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Melisa Tiburcio, Executive Director		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility is not allowing visitors.
Facility failed to report to the department.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wolter contacted the facility on 6/24/2020 to deliver complaint findings via telephone due to COVID-19 and pre-cautionary measures, LPA spoke with Executive Director (ED) Melisa Tiburcio and explained the purpose of the call.

Throughout the course of the investigation LPA reviewed documentation and conducted interviews regarding the allegations: Facility is not allowing visitors and facility failed to report to the department. Interview with Executive Director revealed that on March 2, 2020 a letter to residents and families was sent out regarding the precautions that the facility would be taking in light of COVID-19, at that time visitors were still allowed. Executive Director further told LPA during initial visit on 03/12/2020 that no residents, family members of residents, or staff had tested positive for COVID-19 to the best of her knowledge.

Report xontinued on LIC 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Danyle Wolter	TELEPHONE: (916) 708-5307
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20200306104356

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: VILLAGE AT HERITAGE PARK, THE	FACILITY NUMBER: 342700202
	VISIT DATE: 06/24/2020

NARRATIVE

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Interview with a witness (W1) revealed that it was a misunderstanding and the facility did allow visitors and there were no positive cases that needed to be reported.

Due to this information the department finds the allegation 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.

Exit interview conducted. Copy of report sent to ED via e-mail with read receipt requested to verify delivery. LPA requests that ED prints out report, signs it, and faxes and/or emails a signed copy to Community Care Licensing. A signed copy should also be retained for facility's records.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Danyle Wolter	TELEPHONE: (916) 708-5307
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2020

LIC9099 (FAS) - (06/04)

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