342700369-4-5-2022-27-AS-KHOS-CDGHSV-20220414062747

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700369
Report Date: 04/05/2022
Date Signed: 04/05/2022 04:49:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/17/2021 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20211217141624

FACILITY NAME:	COMMONS AT ELK GROVE, THE		FACILITY NUMBER:	342700369
ADMINISTRATOR:	COURTNEY HILL		FACILITY TYPE:	740
ADDRESS:	9564 SABRINA LANE		TELEPHONE:	(916) 683-6833
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	110	CENSUS: 86	DATE:	04/05/2022
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Meggin Newman Cortez, Executive Director		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility not following Covid 19 precaution high number of death and illness to residents and staff
Facility lack PPE supplies.
Incomplete Training for staff.
Facility not reporting the number of falls
Cockroaches in the Kitchen area
Medication expired in the Assist Living
Finanical Abuse.
Care plans out dated
Someone attacked on grounds and police called.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conclude the investigation on 4/5/22 at 12:15pm. LPA met with Executive Director (ED), Meggin Cortez and stated the purpose of the visit. Upon arrival LPA and ED toured the physical plant, and reviewed resident files.

Regarding allegation,"Facility not following Covid 19 precaution high number of death and illness to residents and staff" LPA observed that the facility has a Mitigation Plan on file with Community Care Licensing (CCL). LPA received a copy of the last four Special Incident Reports (LIC624) of the most recent resident incidents and deaths that occurred in 2020 which were not due to Covid.
Regarding allegation,"Facility lack PPE supplies", LPA observed a room full of PPEs during this visit.
Regarding allegation, "Incomplete Training for staff" LPA observed that staff are trained upon hire, and there is on-going in-services being conducted.
Regarding allegation, "Facility not reporting the number of falls" LPA observed that facility reports falls to CCL by fax and received a copy of the two most current SIRs that was submitted.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022

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 27-AS-20211217141624

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: COMMONS AT ELK GROVE, THE	FACILITY NUMBER: 342700369
	VISIT DATE: 04/05/2022

NARRATIVE

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Regarding allegation,"Cockroaches in the Kitchen area" LPA did not observe any evidence of insects or rodents in the kitchen area and received a copy of the pest control invoice for Dec 2021 and the most recent invoice.
Regarding allegation, "Medication expired in the Assist Living" LPA observed area where medications are kept awaiting for destruction to be picked up by a third party. LPA reviewed the process of destruction with medication staff and received a copy of a random amount of records for residents during this visit.
Regarding allegation,"Finanical Abuse" LPA obtained information that this allegation was not person specific and the rent increase notifications are given timely to residents and/or responsible parties. LPA received a copy of a random amount of resident records regarding rent increases.
Regarding allegation, "Care plans out dated" LPA observed a random amount of resident files and the care plans are updated every 6 months and/or when there is a change in condition.
Regarding allegation,"Someone attacked on grounds and police called" LPA observed that there was an incident that occurred with a staff and their significant other which did not involve residents.

Based on lack of evidence the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be 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.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022

LIC9099 (FAS) - (06/04)

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