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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700471
Report Date: 07/24/2024
Date Signed: 07/24/2024 12:57:13 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
04/15/2024 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 59-AS-20240415163244
FACILITY NAME:COGIR OF STOCK RANCHFACILITY NUMBER:
342700471
ADMINISTRATOR:DAVID JR., RICKYFACILITY TYPE:
740
ADDRESS:7418 STOCK RANCH RDTELEPHONE:
(916) 725-7418
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:99CENSUS: 76DATE:
07/24/2024
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH: Executive Director -Ricky DavidTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff did not meet resident’s dietary needs
Staff did not comply with resident’s admission agreement
Staff did not treat residents with dignity and respect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 findings regarding a complaint the Department received on 04/15/24. LPA met with Executive Director (ED), Ricky David and explained the purpose of the visit.

During the course of the investigation, the Department conducted interviews and obtained pertinent documents relevant to the complaint investigation. Interview with ED revealed that Resident #1 (R1) does not live on the assisted living floors of the facility but on the independent living floor which is not licensed by Community Care Licensing (CCL). Interviews further revealed that the facility did have a meeting with R1 and stated that during the meeting the issues were resolved.LPA interviewed R1 during the interview it was revealed R1 is independent and does not need care and supervision. The department has investigated the complaint alleging resident dietary needs are not being met, staff did not comply with admission agreement and staff did not treat residents with dignity and respect. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted and a copy of the report was left at the facility.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (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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