342700333-12-2-2021-25-AS-MSEY-C9GMY6-20211207090102

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700333
Report Date: 12/02/2021
Date Signed: 12/02/2021 04:20:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/10/2021 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 25-AS-20211110101410

FACILITY NAME:	FAIR OAKS ESTATES INC		FACILITY NUMBER:	342700333
ADMINISTRATOR:	SAROAY, PARVEEN		FACILITY TYPE:	740
ADDRESS:	8845 FAIR OAKS BLVD		TELEPHONE:	(916) 944-2077
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	106	CENSUS: 78	DATE:	12/02/2021
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Kirt Hamberg		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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9

Resident's personal rights violated.
Facility staffing is insufficient to resident needs.
Facility staff did not meet resident's incontinence care needs.

INVESTIGATION FINDINGS:

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On 12/2/21 , Licensing Program Analyst (LPA) Kevin Mknelly LPA Mknelly arrived and met with Licensee to deliver investigation findings. LPA followed Covid protocols for screening and hand sanitizing. LPA wore surgival mask. LPA was screened by receotionist upon arrival.

LPA reviewed stafffacility records, and conducted interviews.
LPA finds that facility met Tittle 22 requirements.

R1 stated in interviews that she was only intending to express issues with her roommate, not her care. R1's care needs are met. R1 has been provided an alternative room and is currently satisfied.

This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.
Exit interview conducted and report provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

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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