342700579-2-2-2023-27-AS-KHOS-CSCHZM-20230531063832

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700579
Report Date: 02/02/2023
Date Signed: 02/02/2023 04:54:03 PM

Substantiated

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
01/27/2023 and conducted by Evaluator Tung Truong

COMPLAINT CONTROL NUMBER: 27-AS-20230127143932

FACILITY NAME:	CHATEAU AT RIVER'S EDGE, THE		FACILITY NUMBER:	342700579
ADMINISTRATOR:	MICHAEL TALANI		FACILITY TYPE:	740
ADDRESS:	641 FEATURE DR		TELEPHONE:	(916) 921-1970
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	143	CENSUS: 88	DATE:	02/02/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Mike Talani		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident wandered from the facility due to lack of supervision by staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tung Truong conducted an unannounced complaint investigation visit to this facility today, 2/2/2023 at 1:00pm to investigate the allegation listed above. LPA met with Administrator, Mike Talani and explained the purpose of today's visit.

During the course of the investigation, LPA interviewed the Administrator on 2/2/2023 and reviewed facility and resident records. Based on the interviews conducted and reviewed of records, it was learned that resident R1 had eloped from the facility on 1/24/23. It was determined at that time based on interviews and record reviews that facility was unaware of R1s general whereabouts on 1/24/23. Review of R1’s LIC 602 revealed that R1 has been determined to be unable to leave the facility unassisted by his physician.

Report continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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-20230127143932

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: CHATEAU AT RIVER'S EDGE, THE	FACILITY NUMBER: 342700579
	VISIT DATE: 02/02/2023

NARRATIVE

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Based on interviews conducted, and records reviewed, the preponderance of evidence standards has been met, therefore, the above allegation(s) is/are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 9099D during this visit. CIVIL PENALTIES ARE ASSESSED IN THE AMOUNT OF $500 today for immediate violations.

Exit interview held, Appeal Rights discussed, copy of report given.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230127143932

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: CHATEAU AT RIVER'S EDGE, THE	FACILITY NUMBER: 342700579
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/03/2023 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411(a)-Personnel Requirements - General-Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met by:	1 2 3 4 5 6 7	The facility shall conduct an in-service training with staff to go over what and how staff shall ensure that residents do not AWOL. Administrator/Executive Director shall send the in-service training materials, plan on how staff will ensure residents do not AWOL and a signature sheet of all staff who attended.
	8 9 10 11 12 13 14	Based on interviews and record review, the facility did not comply with section cited above. R1 AWOL'D from facility. The LIC 602 states the resident was not allowed to leave the facility unassisted. This poses an immediate health and safety risk to the resident in care.	8 9 10 11 12 13 14	The Administrator shall email the date of the in-service training to LPA by 2/3/2023 to meet the 24 hour POC requirement.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC9099 (FAS) - (06/04)

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