342700471-7-24-2024-59-AS-LMUZ-D7J2ZX-20240725175105

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700471
Report Date: 07/24/2024
Date Signed: 07/24/2024 01:01:18 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
03/12/2024 and conducted by Evaluator Cheyenne Ratajczak

COMPLAINT CONTROL NUMBER: 59-AS-20240312162027

FACILITY NAME:	COGIR OF STOCK RANCH		FACILITY NUMBER:	342700471
ADMINISTRATOR:	DAVID JR., RICKY		FACILITY TYPE:	740
ADDRESS:	7418 STOCK RANCH RD		TELEPHONE:	(916) 725-7418
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	99	CENSUS: 76	DATE:	07/24/2024
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Executive Director - Ricky David		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff did not give resident medication as prescribed.
Staff illegally evicted resident  

INVESTIGATION FINDINGS:

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On 07/24/24, Licensing Program Manager (LPM) Laura Munoz and Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Graham Gunby arrived at the facility unannounced to deliver final findings to a complaint the Department received on 03/12/24. LPA met with Executive Director (ED) Ricky David and explained the purpose of the visit.  

During the course of this investigation, the Department conducted interviews, record review and medication review for four (4) residents.  

Please continue to LIC 9099-C….  

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne Ratajczak	TELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

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-20240312162027

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: COGIR OF STOCK RANCH	FACILITY NUMBER: 342700471
	VISIT DATE: 07/24/2024

NARRATIVE

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Allegation: Staff did not give resident medication as prescribed:  
On 03/28/24 LPA Ratajczak and LPA Mirlohi conducted a medication audit for four (4) residents. LPAs compared each residents Medication Administration Record (MAR) with medications centrally stored for the resident. MARs indicated that medications were administered and logged correctly and were given to residents per their doctor's orders.

Based upon the information obtained during investigation, the above allegation is 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.

Allegation: Staff illegally evicted resident  
LPA conducted interviews and a record review of R1s file.  It was suggested by the Health and Wellness Director that R1 gets reevaluated, because R1 was no longer at their baseline. Additionally, the Health and Wellness Director recommended that R1 have a one-on-one. ED was not present during the incident but was aware of what was taking place. ED was planning to put in a referral with their sister community Cogir of Folsom for R1. When the facility notices a change in a resident, the facility will get the resident reevaluated. If it is noted that a higher level of care is needed, the facility will put in a referral to move the resident to their sister community, Cogir of Folsom. During the course of this investigation the department interviewed multiple individuals and was provided with conflicting information regarding if R1 was given a verbal eviction. LPA cannot prove or disprove if a verbal eviction was issued based on the different version of events.

Based upon the information obtained during investigation, the above allegation is 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.

Exit interview conducted a copy of the report and appeal rights were left at the facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne Ratajczak	TELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

LIC9099 (FAS) - (06/04)

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