342700202-8-7-2023-25-AS-LMUZ-CUPT3D-20230814142207

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700202
Report Date: 08/07/2023
Date Signed: 08/07/2023 12:48:41 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
12/28/2022 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 25-AS-20221228105536

FACILITY NAME:	VILLAGE AT HERITAGE PARK, THE		FACILITY NUMBER:	342700202
ADMINISTRATOR:	KAYLA DAVIS		FACILITY TYPE:	740
ADDRESS:	2001 ROSE ARBOR DRIVE		TELEPHONE:	(916) 216-8958
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95835
CAPACITY:	108	CENSUS: 105	DATE:	08/07/2023
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Executive Director Antonette Edwards		TIME COMPLETED:	12:48 PM

ALLEGATION(S):

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Facility staff did not respond to resident's request for assistance in a reasonable amount of time.
Facility staff did not ensure that resident received meals on more than one occasion.

INVESTIGATION FINDINGS:

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On 8/7/23, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Executive Director Antonette Edwards.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

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-20221228105536

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: VILLAGE AT HERITAGE PARK, THE	FACILITY NUMBER: 342700202
	VISIT DATE: 08/07/2023

NARRATIVE

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Facility staff did not respond to resident’s request for assistance in a reasonable amount of time.
The department conducted staff and residents' interviews, reviewed records to investigate the allegation. During residents’ interview, residents stated that staff respond in a timely manner however sometimes there is a delay in response due to staff assisting other resident’s needs. Interviews and record review indicated that resident’s ADL’s which includes residents showering, incontinence and care needs are met as required and documented accordingly. Residents’ interviews indicated that staff were providing care in a professional manner and did not express any concerns. During interviews with facility staff and residents, it has been revealed that facility is providing care to residents according to resident’s needs and service plans. During department visits, department observed that residents appeared to be well groomed and in good care, therefore this allegation ‘Facility staff did not respond to resident’s request for assistance in a reasonable amount of time. ‘is found to be UNSUBSTANTIATED.

Facility staff did not ensure that resident received meals on more than one occasion.
The department conducted staff and residents' interviews, reviewed records and did facility’s observations to investigate the allegation. During resident’s interviews, it has been found out that residents can request their meal tray in their rooms if they do not want to eat in dining room. Residents stated that there were no issues with tray delivery service to their rooms and they did not miss any meals. Staff interviews indicated that they were not aware about any issues with residents missed their meals. During department visit on 07/11/23, LPAs observed meal service for lunch at the facility and did not witness any issues with meal services or tray services to residents' rooms. Based on the information, this allegation is found to be UNSUBSTANIATED.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated.

Exit interview with administrator. Copy of the report provided to facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

LIC9099 (FAS) - (06/04)

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