342700471-8-5-2022-25-AS-APEZ-CHENA7-20220818101701

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700471
Report Date: 08/05/2022
Date Signed: 08/05/2022 12:28:32 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/02/2022 and conducted by Evaluator Michael Hood

COMPLAINT CONTROL NUMBER: 25-AS-20220502144404

FACILITY NAME:	COGIR OF STOCK RANCH		FACILITY NUMBER:	342700471
ADMINISTRATOR:	DAORO-LEHNER, TRACY		FACILITY TYPE:	740
ADDRESS:	7418 STOCK RANCH RD		TELEPHONE:	(916) 725-7418
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	99	CENSUS: 95	DATE:	08/05/2022
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Jenette Mariano, Business Office Coordinator		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Questionable Death

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Business Office Coordinator, Jenette Mariano, to deliver complaint findings into the allegation listed above. LPA wore an N-95 mask. Facility staff wore masks while on the premises.

During the investigation, the Department conducted interviews and requested documentation pertinent to the investigation.

The results of the investigation are as follows:

Allegation: Questionable Death

** Report continued on 9099-C **

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: 916-531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022

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 25-AS-20220502144404

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: COGIR OF STOCK RANCH	FACILITY NUMBER: 342700471
	VISIT DATE: 08/05/2022

NARRATIVE

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Interview with Executive Director (ED), Ricky David, conducted on 6/9/2022 indicated that resident (R1) lived in an apartment on the third floor of the facility, which is designated specifically for independent living and not licensed by Community Care Licensing. ED indicated that no one on the third floor of the facility receives care and supervision.

The Department reviewed R1’s “Independent Living Resident and Services” lease agreement. Agreement states “You have applied to receive accommodations and services in the unlicensed portion of Cogir of Stock Ranch and we have accepted your application.” The agreement states under “Excluded Services” that “We shall not be responsible for furnishing or paying for any of your assisted living (personal care) nursing, or health care needs, including but not limited to acute care; assistance with the tasks of daily living; the services of private duty aides, physicians, and nurses; medications; and other items and services that may require a license to provide.” The agreement also states under “You Capacity for Residential Apartment Living” that “The Residential Housing portion of Cogir of Stock Ranch is not licensed to offer and does not offer assistance with medications, bathing, dressing, mobility needs, supervision, monitoring of your health or safety, or other personal care activities. It is your responsibility to provide for your own health care and personal care needs so long as you reside in Residential Housing. You represent to us that you are capable of providing for your own health care and personal care needs and will provide for all such needs for as long as you reside in Residential Housing.”

Based on interviews conducted by the Department and records reviewed, the Department determines that the Community Care Licensing Division does not have investigation authority regarding residents who reside in the independent living section located on the third floor of the facility as long as the third floor of the facility operates as an independent living, only provides residential housing without care and supervision, and does not admit residents in need of care and supervision to the third floor. Therefore, the above allegation is found to be UNFOUNDED.

Exit interview was conducted with Business Office Coordinator and a copy of this report was provided to the facility. The signature of the Business Office Coordinator on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: 916-531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022

LIC9099 (FAS) - (06/04)

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