342700333-10-12-2023-59-AS-MSEY-CX4L3U-20231030082428

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700333
Report Date: 10/12/2023
Date Signed: 10/12/2023 02:10:28 PM

Unsubstantiated

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
09/21/2023 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 59-AS-20230921115743

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: 100	DATE:	10/12/2023
		UNANNOUNCED	TIME BEGAN:	10:24 AM
MET WITH:	Amar Singh, Resident Care Director		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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-Staff did not ensure that the facility was free of pests
-Residents' food was not prepared in a safe and healthful manner
-Staff provided dirty dishes to residents
-Staff did not ensure kitchen was clean

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, 10/12/23, and met with the Resident Care Director, Amar Singh, to deliver complaint investigation findings into the allegations listed above. The Executive Director was not available today.

During the course of the investigation, LPA conducted interviews, toured the facility, and obtained documentation pertinent to the investigation.

On 9/26/23 and 10/12/23, LPA toured the kitchen, food preparation, food storage, dishwashing, and dining areas of the facility. LPA observed the drains and floors were clean. The food was labeled and stored properly. The dishes were being washed. There were no signs of pests in the food storage, food preparation, dishwashing, or dining areas of the facility.

*********************************************Continued on LIC9099-C***********************************************

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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 3

Control Number 59-AS-20230921115743

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: 10/12/2023

NARRATIVE

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On 9/26/23, LPA observed the hot water temperature used to disinfect dishes was 180 degrees F. The kitchen utilizes a temperature log for food that is prepared to be served to residents and it is updated during each meal. The facility provided the food temperature logs from 9/11/23-9/26/23 to LPA. LPA also observed the tables in the dining area were being cleaned.

On 10/12/23, LPA observed food being served utilizing meal carts in both the memory care and assisted living units of the facility. LPA also observed there were no signs of pests in the hallways or main restroom of the care home.

There was a previous Substantiated complaint with findings delivered on 8/10/23 indicating that the facility had an issue with cockroaches. Since those findings, the facility has hired a professional pest control company to provide pest control services. According to the pest control Service Summary Report dated 8/24/23, the pest control company "treated around the baseboards, behind kitchen appliances, office, break room, storage room, and janitors closet. Fogged using 9 ounces of Shockwave 3% around all kitchen appliances, under tables, backslash, cracks, and crevices. Dusted outlets, wall voids and cracks and crevices for German cockroaches. Heavy German roach pressure throughout the kitchen. Sanitation is a big concern as well as voids needing to be sealed. Please allow 7-10 days for product to take full effect". The Service Summary Report indicated that the area of concern for sanitation was the heavy grease build up around the stove and other kitchen appliances providing a food source for unwanted pests. Interview with staff (S3) indicated that the pest control company was concerned with the tilt skillet. S3 indicated that the tilt skillet was too heavy to move forward and clean behind. S3 indicated that, since the pest control provided services at the facility, the tilt skillet has been removed. S3 indicated that a double steamer will be placed where the tilt skillet once was. LPA observed the removed appliance and did not observe grease build up on the kitchen appliances.

Interview with staff (S4) indicated that they spray the perimeter of the care home for pests. According to the facility's Pest Sight Log, the facility perimeter has been sprayed monthly between 1/12/23-9/20/23.

Interviews conducted with staff (S1 & S2) indicated that the facility kitchen staff never use dirty dishes to serve food to residents. S1 and S2 indicated that they have never witnessed cockroach feces on dishes. S1 and S2 indicated that they have never witnessed cockroaches in the food. S1 and S2 indicated that they have never served food that was undercooked. S1 indicated that they utilize the food temperature log. S2 indicated that there have never been residents sick from or complaining of undercooked food.
*********************************************Continued on LIC9099-C**********************************************

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20230921115743

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: 10/12/2023

NARRATIVE

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Interviews with S1, S2, and S3 indicated that the kitchen staff never keep leftovers or scraps from resident's plates to re-serve. S1, S2, and S3 indicated that leftover food on plates is dumped in the waste basket after each meal.

Interviews with S1, S2, S3, and S4 indicated that the cockroach issue is under control since the facility implemented professional pest control services. Interview with staff (S5) indicated that the professional pest control company has provided services at the facility on 8/24/23, 8/31/23, 9/8/23, and 9/15/23.

Based on observation, interviews conducted, and documentation reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies are being cited during this visit.

Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC9099 (FAS) - (06/04)

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