342700333-2-16-2024-59-AS-MSEY-D2PTPN-20240222135436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700333
Report Date: 02/16/2024
Date Signed: 02/16/2024 04:55:07 PM

Unfounded

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
12/06/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20231206083022

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: 101	DATE:	02/16/2024
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Parveen Saroay, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility staff are not addressing the resident's mental health needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conclude the investigation and issue findings to a complaint received on 12/06/23. LPA met with Parveen Saroay, Administrator, and stated the reason for the inspection.

During today's inspection, LPA interviewed the Administrator, Care Coordinator, and Resident Care Director. LPA also interviewed a representative from the placement agency who has assisted resident (R1) and reviewed R1's physician's report and charting notes. LPA also discussed the allegation with another LPA.

The results of the investigation are as follows:

cont on 9099C-1...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

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-20231206083022

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: 02/16/2024

NARRATIVE

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9099C-1..Allegation: Facility staff are not addressing the resident's mental health needs. The allegation states (R1) is isolated 24/7, neglected with nobody to talk to about her fears and nobody cares. The allegation also states that (R1) has been offered mental health services, but (R1) has declined and that (R1) shares a room with another resident who has recently provided her 30-day notice to leave the facility.

Resident moved in on/around 11/30/23 with a diagnosis of PTSD, low appetite, arthritis, and anxiety. The physician's report states resident can also be depressed. The Administrator stated (R1) was very happy to move in to the community after taking a lengthy tour and wanted to move in immediately. Staff interviews indicated that resident is independent with all activities of daily living (ADL's) and can schedule and attend her own medical appointments.

Regarding (R1) being isolated 24/7 and neglected
Charting notes dated 12/11/23 state resident doesn't feel the community is appropriate and wants the community to help her find a more suitable place for her needs. Charting notes from 12/12/23 document a care conference was held with facility managers and the Ombudsman and resident expressed that she would like to have someone to talk to about any concerns, so the Care Coordinator was assigned to meet weekly with her for 30 minutes. Notes entered on 1/13/24 state resident expressed concerns about having nightmares and was advised by facility staff to contact her primary doctor. Additional notes show staff has consistently taken follow up action to address concerns brought to their attention, including repairs in resident's room and with food service. Notes entered on 2/13/24 state resident was frustrated with her situation of trying to get an answer on her eligibility for a particular program, and resident was referred to the assigned LPA to discuss her concerns. LPA Hood confirmed she spoke in length with resident on/around 2/13/24.

All facility interviews confirmed that when resident first moved in, she would stay in her room, including during meals, and would not participate in activities or socialize with the other residents. These interviews also confirmed that resident has made significant progress since moving in and will now eat meals in the dining room, is willing to talk to other residents, participates in some activities and has been going to the Wednesday in-house store. Staff indicated that resident has changed her behavior based largely on the trust built from the weekly 1:1 meetings with the Care Coordinator. In addition, phone calls to the front desk have significantly decreased along with complaints made. Resident was not available to speak to LPA during today's inspection.

cont on 9099C-2..

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20231206083022

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: 02/16/2024

NARRATIVE

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9099C-2. Charting notes from 12/12/23 state resident felt she has no one to talk to, wants someone to talk to and the facility offered a support group they have, and resident declined. Facility staff confirmed that, in addition to providing a weekly 1:1 staff to listen to resident's concerns, shortly after resident moved in, they have offered to assist resident in any other way she has asked. This includes assisting her in finding another community, contacting her doctor or placement agency, and suggesting she contact her health care plan for available services. A representative from the placement agency stated that resident was offered mental health services on three occasions but declined.

Facility staff interviews concluded that resident had more issues with the placement agency in not being able to assist her as quickly as she would like, than with the facility. Interviews confirmed that although resident liked the staff and community in general, she wishes to reside at a community with younger adults, close to her in age.

Regarding resident sharing a room with another resident who recently provided a 30-day notice- all interviews conducted confirmed that (R1) has not had a roommate since moving to the facility. Interviews confirmed resident has anxiety about having a shared room but may need to move into shared room in the near future.

Based on information obtained, LPA finds the allegation: Facility staff are not addressing the resident's mental health needs, to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview. Copy of report provided to the Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

LIC9099 (FAS) - (06/04)

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