342700471-7-21-2020-27-AS-MSEY-BRQQ6M-20200721115343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700471
Report Date: 07/20/2020
Date Signed: 07/21/2020 09:21:27 AM

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
04/21/2020 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 27-AS-20200421154631

FACILITY NAME:	STOCK RANCH ROAD RTRMT COM-HAPPY LVNG BY COGIR/COG		FACILITY NUMBER:	342700471
ADMINISTRATOR:	AMPALAYO, ANNE-MARIE		FACILITY TYPE:	740
ADDRESS:	7418 STOCK RANCH RD		TELEPHONE:	(916) 725-7418
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	99	CENSUS: 65	DATE:	07/20/2020
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Carie Baker		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff failed to keep the facility free from infestation

Staff is not following proper sanitation procedures

INVESTIGATION FINDINGS:

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On 7/20/20, Licensing Program Analyst (LPA) Kevin Mknelly spoke to Carie Baker, Regional Operations Director of facility Stock Ranch Road – 342700471 at approximately 10 AM. LPA was unable to meet at the facility due to current circumstances.

LPA conducted extensive interviews with staff and reviewed facility records.

LPA is unable to find and or meet the preponderance, per policy.
Regarding the allegation that staff failed to keep the facility free from infestation, facility records and staff interviews noted that there were increased observations of insects on the grounds of the facility in March 2020. When staff observed insects being found inside the facility, management was informed, and pest control services records show that services were initiated on 3/17/20. Additional measures were taken by

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2020

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-20200421154631

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: STOCK RANCH ROAD RTRMT COM-HAPPY LVNG BY COGIR/COG	FACILITY NUMBER: 342700471
	VISIT DATE: 07/20/2020

NARRATIVE

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the facility to reduce outdoor insects’ access to the kitchen area of the facility. The exact timeline for when insects gained access to the building to when preventative measures were initiated was unable to be determined due to lack of availability of specific records or staff recall of specific dates.

Regarding the allegation that staff is not following proper sanitation procedures, facility records and staff interviews noted that with the changes to in-room versus dining room services due to Covid-19, the facility’s “kitchen and dining room clean-up duty” sign off was not consistently completed. However, interviews indicated that the tasks were completed but the forms were not. Beginning in June 2020, the clean-up duty sign-off sheets are again thoroughly completed as the facility was reinstituting modified dining room services.

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.
As a result of this investigation, no deficiencies were cited, per Title 22 Regulations, Division 6.

Unable to obtain signature. Signature present on hard copy in file. LPA sent a copy of report for Administrator, ( )to sign. Administrator to send a signed copy back to CCL.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2020

LIC9099 (FAS) - (06/04)

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