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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700307
Report Date: 06/14/2022
Date Signed: 06/14/2022 10:22:49 AM

Unfounded


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
03/22/2022 and conducted by Evaluator Tung Truong
COMPLAINT CONTROL NUMBER: 27-AS-20220322145513
FACILITY NAME:BLESSED HOME FOR SENIORS IIIFACILITY NUMBER:
342700307
ADMINISTRATOR:GATCHALIAN, AIDAFACILITY TYPE:
740
ADDRESS:10070 KNOTTS DRTELEPHONE:
(916) 895-2890
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:6CENSUS: 5DATE:
06/14/2022
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Aida GatchalianTIME COMPLETED:
10:35 AM
ALLEGATION(S):
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Resident was sexually abused while in care.
INVESTIGATION FINDINGS:
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On 6/14/22, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit to this facility to conclude the investigation of the above allegation and to deliver the findings. LPA met with Administrator Aida Gatchalian and explained the purpose of the visit.

The investigation was conducted by the Department which consisted of reviews of the medical records and interviews with facility management and staff. The complaint alleged that resident (R1) was sexually abused while in care. The investigation revealed that one of the residents was interviewed. During today's visit, LPA Truong attempted to interview 3 residents but were unable to obtain any information due to their cognitive ability to verbalize and dementia.

Continued on 9099-C
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
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 2
Control Number 27-AS-20220322145513
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: BLESSED HOME FOR SENIORS III
FACILITY NUMBER: 342700307
VISIT DATE: 06/14/2022
NARRATIVE
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Throughout the course of the investigation, the Department conducted interviews and reviewed medical records. The investigation revealed that resident’s (R1) primary diagnosis was dementia. It was learned that R1 does not have the cognitive ability to verbalize or recall if she was sexually abused. Other residents in care were unable to provide any information of the incident due to dementia. According to Elk Grove Police Department officers who responded to the incident determined that no sexual assault occurred. R1's medical records revealed that there were no signs of abuse. Furthermore, a male caregiver who was suspected to be the perpetrator was not working on the day of the incident.

This Department has investigated the allegation noted above and have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint.

Exit interview was conducted with Administrator Aida Gatchalian and a copy of the report was provided.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2