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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700333
Report Date: 05/03/2023
Date Signed: 05/03/2023 11:27:42 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
01/23/2023 and conducted by Evaluator Kevin Mknelly
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20230123140629
FACILITY NAME:FAIR OAKS ESTATES INCFACILITY NUMBER:
342700333
ADMINISTRATOR:SINGH, GURSHAHBAZFACILITY TYPE:
740
ADDRESS:8845 FAIR OAKS BLVDTELEPHONE:
(916) 944-2077
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:106CENSUS: 100DATE:
05/03/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Parveen SaroayTIME COMPLETED:
11:35 AM
ALLEGATION(S):
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Staff allows resident to engage in physical behavior with other residents in care.
Staff are mismanaging resident's medications.
Staff are not meeting resident's showering needs.
Staff speak inappropriately about residents in the presence of other residents.
Staff are not following resident's list of food allergies.
Staff are not reporting falls to the appropriate entities.
Staff are not changing residents timely.
Residents are not being repositioned every two hours.
Neglect/lack of care and supervision resulted in a client assaulting other clients in care.
INVESTIGATION FINDINGS:
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On 5/3/23, Licensing Program Analyst (LPA) Kevin Mknelly spoke with the Administrator. The reason for the visit was to deliver findings for the allegation sited above. Upon entering the facility, sign in.

While conducting this investigation, LPA reviewed resident records and conducted extensive interviews.
LPA finds that the allegation cited above are Unsubstantiated.
Findings are as follows:

Staff allows resident to engage in physical behavior with other residents in care. Records review and interviews regarding R4 issues found that R4 is diagnosed with dementia. Increased monitoring and redirection interventions for R4 addressed interactions with R4 and other residents. R4 was also increased to two staff assist with bathing to reduce the incidents between R4 and female caregivers.
Report continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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 4
Control Number 25-AS-20230123140629
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: FAIR OAKS ESTATES INC
FACILITY NUMBER: 342700333
VISIT DATE: 05/03/2023
NARRATIVE
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Staff are mismanaging resident's medications. Responding to a 10/10/22 complaint, this allegation was substantiated 3/10/23. The licensee completed the necessary plan of correction. Insufficient details were provided in this allegation and no evidence supporting it during records reviews and interviews.
Staff are not meeting resident's showering needs. Interviews and records review found that identified and contracted shower options were provided for residents identified in the complaint.
Staff speak inappropriately about residents in the presence of other residents. Interview statements of two staff were not supported by four staff interviewed.
Staff are not following resident's list of food allergies. Interviews and records did not substantiate this complaint.
Staff are not reporting falls to the appropriate entities. For reported falls, records and interviews found that required reporting was done.
Staff are not changing residents timely. Records reviews and interviews found that the residents identified were provided the opportunity for incontinence care in accordance with their care plans.
Residents are not being repositioned every two hours. No specific residents were identified in the complaint. A sample of three residents needing repositioning found them to have identified repositioning and to be free of skin breakdown.
Neglect/lack of care and supervision resulted in a client assaulting other clients in care. Records review and interviews failed to find incidents that occurred between residents which were not responded to appropriately by staff.

As a result of this investigation, LPA finds allegation to be (US)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 with administrator. Report provided
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
01/23/2023 and conducted by Evaluator Kevin Mknelly
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20230123140629

FACILITY NAME:FAIR OAKS ESTATES INCFACILITY NUMBER:
342700333
ADMINISTRATOR:SINGH, GURSHAHBAZFACILITY TYPE:
740
ADDRESS:8845 FAIR OAKS BLVDTELEPHONE:
(916) 944-2077
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:106CENSUS: 100DATE:
05/03/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Parveen SaroayTIME COMPLETED:
11:35 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff sexually abuses residents while in care.
Staff do not ensure residents are properly clothed.
Staff do no provide activities to residents in care.
Untrained staff.
Facility is malodorous.
INVESTIGATION FINDINGS:
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On xx/xx/xx, Licensing Program Analyst (LPA) Kevin Mknelly spoke to xxxxx xxxxxx. The reason for the visit was to deliver findings for the allegation sited above. Upon entering the facility, analyst completed electronic screening and sign in. Analyst followed facility's policy and wore a surgical mask.

While conducting this investigation, LPA reviewed resident records and conducted extensive interviews.
LPA finds that the allegation cited above are Unfounded.

Staff sexually abuses residents while in care. Records review and interviews found no credible evidence that an issue of sexual abuse occurred at the facility as reported.
Staff do not ensure residents are properly clothed. Records review and interviews found that the identified resident is assisted and monitored for proper clothing.

Report continued...
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 25-AS-20230123140629
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: FAIR OAKS ESTATES INC
FACILITY NUMBER: 342700333
VISIT DATE: 05/03/2023
NARRATIVE
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Staff do no provide activities to residents in care. Records review and interviews found that the licensee employs a full-time activities coordinator. Specific to residents in memory care, activities are available and utilized when or if residents are able to participate.
Untrained staff. Records reviews and interviews found training was provided as required and that there were two staff found to not have completed training at the time they discontinued employment but had not yet worked individually with residents.
Facility is malodorous. Inspections and interviews found that while there are occasions of malodorousness at the facility when residents are assisted with incontinence care, those odors are responded to and residents are assisted when needed.

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.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4