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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700579
Report Date: 05/23/2023
Date Signed: 05/23/2023 04:18:43 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, THEFACILITY NUMBER:
342700579
ADMINISTRATOR:MICHAEL TALANIFACILITY TYPE:
740
ADDRESS:641 FEATURE DRTELEPHONE:
(916) 921-1970
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:143CENSUS: 84DATE:
05/23/2023
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Pam Munday, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility did not adhere to the Admission Agreement.
Facility raised resident's rate without proper notification.
INVESTIGATION FINDINGS:
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On 5/23/2023, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit the facility to conclude the complaint investigation regarding the allegations above. LPA met with Interim Administrator Pam Munday and stated the reason for the visit.

Throughout the course of the investigation, LPA conducted interviews and reviewed records. Regarding the allegation that facility did not adhere to the Admission Agreement, it was learned that resident (R1) eloped from the facility on 1/24/23 without staff noticing. Per Admission Agreement, its stated that facility will ensure proper supervision of R1 with the use of exiting monitoring alert, wander guard band. The facility did not fulfill its obligation as stated in the Admission Agreement and failed to properly monitor R1 from exiting the facility. A review of the wander guard alarm log for 1/24/2023 revealed that there was no record of R1's wander guard alarm alert from 1:45pm to 2pm.

Report continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
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: 05/23/2023
NARRATIVE
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Regarding the allegation of facility raised resident's rate without proper notification, it was learned that facility did not provide R1 and R1’s representative any written notice of the rate increases due to change in level of resident care. According to Health and Safety Code 1569.657, for any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increases within two business days after initially providing services at the new level of care.

Based on LPAs observations and interviews which were conducted and record interview(s), the preponderance of evidence standards has been met, therefore, the above allegation(s) is found to be SUBSTANTIATED. Deficiencies are cited on the LIC 9099-D, per Title 22 Regulations and California Health and Safety Code.

Exit interview was conducted, a copy of the report, LIC 9099-D and appeal rights were provided.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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, THEFACILITY NUMBER:
342700579
ADMINISTRATOR:MICHAEL TALANIFACILITY TYPE:
740
ADDRESS:641 FEATURE DRTELEPHONE:
(916) 921-1970
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:143CENSUS: 84DATE:
05/23/2023
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Pam MundayTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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9
Facility staff did not maintain resident's room in a clean and sanitary condition.
INVESTIGATION FINDINGS:
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On 5/23/2023, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit the facility to conclude the complaint investigation regarding the allegation above. LPA met with Interim Administrator Pam Munday and stated the reason for the visit.

Throughout the course of the investigation, LPA conducted interviews and reviewed records. Based on interviews and records review, the allegation mentioned above were deemed unfounded. Resident (R1) corroborated that facility staff have maintained resident’s room in a clean and sanitary condition. Moreover, LPA observed R1’s room was kept clean and sanitary during previous visit at the facility.

As a result of this investigation, LPA finds the allegation above to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis.

An exit interview was conducted, and a copy of this report was left at the facility.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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: 05/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
05/24/2023
Section Cited
CCR
87507(f)
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87507(f) Admission Agreement. The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments.
This requirement is not met as evidence by:
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The Administrator will review the admission agreement and title 22 regulation 87507 in its entirety. Written documents will be submitted to CCL explaining how they will assure that moving forward, they will comply with their admission agreement. The documents must be submitted to CCL by POC due date 5/24/2023.
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Based on interviews and record review, the licensee did not comply with admission agreement to ensure resident R1 is properly monitored. Resident R1 eloped from the facility without staff noticing as a result of R1's wander guard is not working. The poses an immediate health and safety risk to residents in care.
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Request Denied
Type B
05/30/2023
Section Cited
HSC
1569.657(a)
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§1569.657 Rate increase due to change in level of resident care; notice. (a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increases within two business days after initially providing services at the new level of care. This requirement is not met as evidence by:
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Administrator shall provide a proper written notice of rate increase to resident and/or residents responsible party with a re-assessment as well as detailed reasons as of why there is a rate increase and provide a detailed rate increase sheet showing what services will be made available to R1 for increased safety. Licensee will provide a copy of written notice to CCL office by POC date 5/30/2023.
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Based on interviews and record review, the licensee did not provide R1 and R1's representative any written notice of rate increases due to change in level of care within two days as required. The poses a potential health and safety risk to residents in care.
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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-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4