342700579-12-13-2023-27-AS-KHOS-CZZLFE-20240131074259

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700579
Report Date: 12/13/2023
Date Signed: 12/13/2023 04:01:06 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
12/06/2023 and conducted by Evaluator Arvin Villanueva

COMPLAINT CONTROL NUMBER: 27-AS-20231206120154

FACILITY NAME:	CHATEAU AT RIVER'S EDGE, THE		FACILITY NUMBER:	342700579
ADMINISTRATOR:	MUNDAY, PAMELA		FACILITY TYPE:	740
ADDRESS:	641 FEATURE DR		TELEPHONE:	(916) 921-1970
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	143	CENSUS: 105	DATE:	12/13/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Grace Hartnett, Interim Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

The facility is in disrepair.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 12/13/23 at 10:00am, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived at this facility unannounced to open and investigate the complaint allegations noted above. LPAs met with the facility's Interim Administrator, Grace Hartnett, and explained the purpose of the visit.

During this visit, LPAs Bilger and Villanueva conducted facility observation and staff interviews. Additionally, LPAs conducted facility file reviews. LPAs requested copies of the following documents for review: pest control agreement, facility admission policy and processes, resident move-in coordination documents, medication administration record (MAR) for November and December 2023, list of new adminssions for November and December 2023, and menu for November and December 2023.

{Con't on LIC9099-C}

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) -26-4700
LICENSING EVALUATOR NAME: Arvin Villanueva	TELEPHONE: 916-558-2130
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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-20231206120154

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CHATEAU AT RIVER'S EDGE, THE	FACILITY NUMBER: 342700579
	VISIT DATE: 12/13/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

{Con't from LIC9099}

For the allegation, facility is in disrepair, during a facility observation in the first floor of the facility, LPAs observed a door that is in disrepair located near the laundry room and memory care entrance. Grace Hartnett, the interim administrator, confirmed the door in question to be a fire door. The upper part of the door was peeled off and the inside of the door is exposed. Additionally, when LPAs tried to release the door from its magnet, the door would get stuck to the carpet and was observed the door to not function or close properly as intended. At 3:30pm, LPAs observed facility staff conduct fire alarm test. LPAs observed that the damaged door did not released from its magnet, therefore, the door did not closed as intended for fire safety. Based on observation and interviews conducted, the allegation that the facility is in disrepair is SUBSTANTIATED. A finding of substantiated means that the preponderance of evidence standard has been met.

An exit interview was held with the interim administrator, Grace Hartnett, and a copy of this report and appeal rights were provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) -26-4700
LICENSING EVALUATOR NAME: Arvin Villanueva	TELEPHONE: 916-558-2130
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 27-AS-20231206120154

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CHATEAU AT RIVER'S EDGE, THE	FACILITY NUMBER: 342700579
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/12/2023 Section Cited CCR 87203	1 2 3 4 5 6 7	87203 Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee to repair or replace a new fire door to function property for safety protocol. A written plan to repair or replace to be submitted to the Department by the POC due date. LPA will conduct a POC visit at a late date.
	8 9 10 11 12 13 14	Based on observation and interview, a fire door located near the memory care of the facility was observed to be not functioning and not closing properly when released from its magnet, which poses an immediate health, safety and personal rights risk to the persons in care.	8 9 10 11 12 13 14
Type B 12/20/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation: (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee to repair or replace a new fire door. A written plan to repair or replace to be submitted to the Department by the POC due date. LPA will conduct a POC visit at a late date.
	8 9 10 11 12 13 14	Based on observation and interview, a fire door located near the memory care area of the facility was observed to be in disrepair which poses a potential health, safety and personal rights risk to the persons in care.	8 9 10 11 12 13 14

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: Stephen Richardson	TELEPHONE: (916) -26-4700
LICENSING EVALUATOR NAME: Arvin Villanueva	TELEPHONE: 916-558-2130
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4