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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700333
Report Date: 08/10/2023
Date Signed: 08/10/2023 04:45:48 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
06/09/2023 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20230609135819
FACILITY NAME:FAIR OAKS ESTATES INCFACILITY NUMBER:
342700333
ADMINISTRATOR:SAROAY, PARVEENFACILITY TYPE:
740
ADDRESS:8845 FAIR OAKS BLVDTELEPHONE:
(916) 944-2077
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:106CENSUS: 100DATE:
08/10/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Parveen SaroayTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not dispense medications as prescribe to residents (cited on 8/1/23)
Staff not taking proper measures to eradicate cockroaches in the facility
Staff do not provide meals of the quality necessary.
INVESTIGATION FINDINGS:
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 On 8/10/23, Licensing Program Analyst (LPA) Kevin Mknelly spoke to Administrator Parveen Saroay to deliver complaint findings for the above allegation.
LPA reviewed resident records, facility records and conducted extensive interviews.
LPA finds that the allegations cited above are substantiated.
Staff did not dispense medications as prescribe to residents- this investigation ran concurrently with complaint number 59-AS-20230601112833. Records and interviews found that two residents did not receive medications as prescribed due to refilling errors on the part of staff and the pharmacy. This violation was cited on 8/1/23 involving the same error for the same residents. Additional ciation not done for this case.
Staff not taking proper measures to eradicate cockroach infestation- Interviews and observations found cockroaches in the kitchen and adjacent staff break areas were treated by facility maintenance staff during the period of May- August 2023 without advice from professional exterminators and cockroaches continued to be present in the kitchen throughout the period of this investigation from 6/14/23 through 8/10/23.
Report continued
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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 6
Control Number 59-AS-20230609135819
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: FAIR OAKS ESTATES INC
FACILITY NUMBER: 342700333
VISIT DATE: 08/10/2023
NARRATIVE
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Staff do not provide meals of the quality necessary- On 6/14/23 unsanitary food storage was found by LPA at the facility. Items identified in the kitchen refrigerator were tuna salad dated 6/9/23, Cheddar cheese in a plastic container dated 5/30/23 and contained mold. Interviews found that the facility had changes in kitchen staff and had food storage practices that failed to adhere to food safety guidelines for storage of perishable foods and use of leftovers.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

Report reviewed with Parveen Saroay . Copy of this report and appeal rights provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 59-AS-20230609135819
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: FAIR OAKS ESTATES INC
FACILITY NUMBER: 342700333
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/11/2023
Section Cited
CCR
87555(b)(7)
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General Food Service Requirements (b)The following food service requirements shall apply: (27)
All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.
This requirement was not met based on observations and interviews that found a
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Licensee will submit a plan to utilize a professional pest control company for service to begin no later than 8/18/23 and to plan a deep cleaning of all areas of the kitchen.

The POC is due by 8/11/23.

To be cleared by POC visit.
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cockroach infestation reported to have started in May 2023 and is yet remedied by the time of this report.
This poses an immediate rish to resident health.
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Type A
08/11/2023
Section Cited
CCR
87555(b)(9)
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General Food Service Requirements (b)(9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service.
This requirement was not met based on observations and interviews that found
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Licensee will submit a plan to create written food storage, disposal and monitoring procedures that insure expired and contaminated foods are discarded. The plan will also contain provisions for staff training of procedures. Procedures and training to be completed no later that 8/21/23
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expired and contaminated food on 6/14/23.
This posed an immediate health and safety risk to residents.
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Plan/ POC due by 8/11/23.

To be cleared by POC visit.
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: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
06/09/2023 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20230609135819

FACILITY NAME:FAIR OAKS ESTATES INCFACILITY NUMBER:
342700333
ADMINISTRATOR:SAROAY, PARVEENFACILITY TYPE:
740
ADDRESS:8845 FAIR OAKS BLVDTELEPHONE:
(916) 944-2077
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:106CENSUS: DATE:
08/10/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Parveen SaroayTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff do keep the facility clean
Staff do not meet the showering needs of residents
Staff do not ensure residents have clean clothing to wear
Staff leave residents in soiled incontinence underwear for extended periods of time
Staff do not provide meals of the quantity necessary
INVESTIGATION FINDINGS:
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On 8/10/23, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Administrator.

LPA conducted records review and extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.

Staff do keep the facility clean- LPA conducted 5 inspections during the course of this investigation. Observations did not support that the facility staff fail to clean the resident rooms or common areas. The exception to this are those allegations related to food storage and pest control in the kitchen area of the facility which are cited elsewhere in this report.

Staff do not meet the showering needs of residents- Records and interviews did not find evidence of staff failing to provide opportunities to bathe. Showers, at times were rescheduled and residents, at times, refuse showers when offered.
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: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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 6
Control Number 59-AS-20230609135819
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: FAIR OAKS ESTATES INC
FACILITY NUMBER: 342700333
VISIT DATE: 08/10/2023
NARRATIVE
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Staff do not ensure residents have clean clothing to wear- Observations and interviews found residents were observed to wear the clothing they choose and resident concerns regarding laundry service were generally resolved timely.

Staff leave residents in soiled incontinence underwear for extended periods of time- Interviews of resident and staff found several occasions where residents at times were non-compliant to incontinence care or instances were explained in interviews that incontinence care was provided and was followed by a repeat incident that was not readily identified. Once identified, care was reportedly provided as needed. Additionally, LPA observed several occasions where resident rooms had urine odors due to soiled incontinence products were left in resident room. LPA advised development and maintenance of written incontinence management plans are required.

Staff do not provide meals of the quantity necessary- Records and interviews found that residents are provided meals which follow Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. Interviews with residents found that some felt portions were sufficient and some wished for larger. LPA advised that regardless of resident compliance to prescribed diets, special diets be readily available.

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

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
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
06/09/2023 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20230609135819

FACILITY NAME:FAIR OAKS ESTATES INCFACILITY NUMBER:
342700333
ADMINISTRATOR:SAROAY, PARVEENFACILITY TYPE:
740
ADDRESS:8845 FAIR OAKS BLVDTELEPHONE:
(916) 944-2077
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:106CENSUS: DATE:
08/10/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Parveen SaroayTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff stole from residents-
Staff not taking proper measures to eradicate bed bugs infestation
INVESTIGATION FINDINGS:
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 On 8/10/23, Licensing Program Analyst (LPA) Kevin Mknelly LPA Mknelly arrived and met with Administrator to deliver investigation findings.
LPA reviewed staff records, facility records, and conducted interviews.
LPA finds that facility met Tittle 22 requirements.
Facility theft loss records identified that the IPad reported resident as having been stolen was found in the facility and returned to the resident within 2 days.
The facility experienced one (1) documented episode of bed bugs in residents’ room which were treated by maintenance staff. Interviews statements implied there were more cases yet lacked specific detailes or evidence.
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 SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 6