342700202-8-7-2023-59-AS-LMUZ-CV6U2Y-20230829151243

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700202
Report Date: 08/07/2023
Date Signed: 08/07/2023 12:57:48 PM

Substantiated

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
03/17/2023 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20230317152307

FACILITY NAME:	VILLAGE AT HERITAGE PARK, THE		FACILITY NUMBER:	342700202
ADMINISTRATOR:	KENT MULKEY		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:	12:57 PM

ALLEGATION(S):

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Insufficient staffing levels

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**

Substantiated

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)

Page: 1 of 5

Control Number 59-AS-20230317152307

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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Allegation: Insufficient staffing levels.

LPA interviewed staff, residents and reviewed documentation to investigate this allegation. This facility is currently on a (3) three-year probation with the department under a stipulation agreement. This stipulation was adopted on January 5, 2023. Based on Stipulation, page 8, section 2, paragraph AA:
There shall be a minimum of three (3) qualified direct care employees in the memory care unit during the morning and evening shifts, not including the person responsible for dispensing medication. There shall be a minimum of two (2) direct care employees in the memory care unit during the overnight shift, not including the person responsible for dispensing medication. In the event of a substantial reduction in the census, Respondents may request a reduction in minimum staffing ratios from licensing. In the event of a substantial increase in the census, licensing may increase the required minimum staffing ratios.

Based on interviews and records review, the facility is not meeting agreed staffing ratios. Records indicated the facility did not meet staffing ratio requirements on the following dates for Memory Care Unit : AM shift April 2, 3, 16, 17; PM Shift April 6, 9, 11, 15, 16, 23, 24 and NOC shift April 4, 11, 18, 25.

Based on LPA's observations and interviews which were conducted, and record reviewed, the facility did not comply with staffing ratios within the agreed terms of a stipulation. The preponderance of evidence standard has been met; therefore, the above allegation(s) are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6& Chapter 8), are being cited on the attached LIC 9099D.

Exit interview with administrator. Appeals rights provided. 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)

Page: 2 of 5

Control Number 59-AS-20230317152307

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/07/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/08/2023 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidence by;	1 2 3 4 5 6 7	Licensee shall submit a plan to the department how the facility will ensure and maintain stipulation staffing ratios in the memory care unit. In addition, the facility shall submit staffing plans with timesheet entries for all staff who work in the memory care unit for the next 90 days. Facility shall submit POC by due date 8/8/23.
	8 9 10 11 12 13 14	Based on the record review and staff interviews, the facility does not have sufficient staffing numbers based on stipulation agreement for memory care unit which poses an immediate safe and healthy risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

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 appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
03/17/2023 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20230317152307

FACILITY NAME:	VILLAGE AT HERITAGE PARK, THE		FACILITY NUMBER:	342700202
ADMINISTRATOR:	KENT MULKEY		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:	12:57 PM

ALLEGATION(S):

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Staff are not responding to call buttons in a timely manner.
Insufficient staff training.

INVESTIGATION FINDINGS:

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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)

Page: 4 of 5

Control Number 59-AS-20230317152307

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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Staff are not responding to call buttons in a timely manner.
The department conducted staff and residents' interviews, reviewed records to investigate the allegation. During residents’ interview, residents stated that staff respond to their call buttons in timely manner however sometimes there is a delay in response due to staff assisting other resident’s needs. During call button log review, department did not observe any long/extended wait times from staff to respond to resident's call button, therefore this allegation is ‘staff are not responding to call buttons in a timely manner ‘ is found to be UNSUBSTANTIATED.

Insufficient staff training.
The department conducted staff and residents' interviews, reviewed records to investigate the allegation. Based on interviews with staff, staff indicated that training was conducted at the time of hire and on a continuous basis per department regulations. The department reviewed staff training records and observed that training requirements were met. Staff interviews indicated that staff have required mandated training upon hire and on a continuous basis per facility needs and requirement. Records reviewed indicated that the facility kept proper record of all staff training for all staff without any issues. Though training requirements are met, meaning classes were taken; the department cannot determine if all staff understood the training and applied it appropriately. Based on this information, this allegation is 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)

Page: 5 of 5