342700333-4-11-2024-59-AS-MSEY-D4CMY7-20240415100103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700333
Report Date: 04/11/2024
Date Signed: 04/11/2024 02:43:46 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
03/22/2024 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 59-AS-20240322100504

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: 104	DATE:	04/11/2024
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Parveen Saroay, Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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-Licensee is not keeping the facility free from pests

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Hood arrived unannounced at the care home today, 4/11/24, and met with the Executive Director, Parveen Saroay, to deliver complaint investigation findings into the above stated allegation.

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

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 monthly and as needed. The pest control service company provides routine indoor and outdoor services as well as additional services checking/spraying 4 resident bedrooms. The facility provided invoices indicating that pest control services were provided on 3/5/24 and 4/2/24.
*******************************************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: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

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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Control Number 59-AS-20240322100504

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: 04/11/2024

NARRATIVE

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On 3/26/24, LPA observed 2 residents' (R2, R3, R4, and R5) bedrooms and the dining area. LPA did not observe any signs of pests in the bedrooms or dining room area.

Interviews with R2 and R5 indicated that they have never seen pests in the care home. Interview with R3 indicated that they had seen cockroaches at the care home but have not seen any since the last three sprays that the pest control company provided.

Interview with staff (S1) indicated that they have not seen any pests in the care home. Interview with the Executive Director and staff (S2) indicated that the pest control company provides services monthly and will be contacted for any additional services, if needed. Interviews also indicated that facility will select 4 residents' rooms to be sprayed for pests monthly.

On 4/11/24, LPA conducted an annual inspection of the care home and did not observe any signs of pests. LPA observed resident (R1's) room. R1's room had four traps for pests. LPA observed 3 gnats on one trap and no pests on the other traps. R1's room has double doors that lead to an outdoor patio that can be utilized by R1.

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

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: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

LIC9099 (FAS) - (06/04)

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