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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700579
Report Date: 03/05/2024
Date Signed: 03/05/2024 03:23:01 PM


Document Has Been Signed on 03/05/2024 03:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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, THEFACILITY NUMBER:
342700579
ADMINISTRATOR:MUNDAY, PAMELAFACILITY TYPE:
740
ADDRESS:641 FEATURE DRTELEPHONE:
(916) 921-1970
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:143CENSUS: DATE:
03/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Marianne RichardsonTIME COMPLETED:
03:30 PM
NARRATIVE
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On 3/5/2024 at 2:30PM Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to conduct a case management visit. LPA met with Marianne Richardson, current Executive Director (ED) and explained the purpose of this visit. During the course of the investigation into complaint control number 27-AS-20231121160532, deficiencies were identified which are being addressed by this case management. During the course of the investigation for the above listed complaint, facility observations, record reviews and interviews were conducted.

During the course of the investigation, it was revealed through interview of S1 and R1’s responsible party (RP) that R1 was not served meals since the day R1 moved in on 11/18/23. Interview with the RP revealed that R1 had access to Glucerna which it appears R1 consumed based on empty bottles that were observed when one of R1’s family member visited R1 unannounced on 11/21/23 at 12:28pm. Review of facility’s meal logs from 11/19/23 to 11/21/23 (breakfast) revealed no record of R1 being served breakfast, lunch, and/or dinner. Review of facility’s meal logs from 11/22/23 to 11/30/23 revealed R1 being served at least 3 meals per day.

As a result of this case management, a deficiency was observed (see LIC 809-D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Failure to correct the deficiency may also result in civil penalties.


An exit interview was conducted with Marianne Richardson and a copy of this report and appeal rights were provided.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) -26-4700
LICENSING EVALUATOR NAME: Arvin VillanuevaTELEPHONE: 916-558-2130
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/05/2024 03:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/06/2024
Section Cited
CCR
87555(b)(1)

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87555 General Food Service Requirements: (b) (1) Where all food is provided by the facility arrangements shall be made so that each resident has available at least three meals per day...Not more than fifteen (15) hours shall elapse between the third and first meal.
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Licensee to submit a statement of understanding regarding CCR 87555 to the Department by the POC due date.
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This requirement is not met as evidenced by:
Based on record reviews and interviews, the licensee did not ensure R1 received at least three meals per day from 11/19/23 to 11/21/23 at breakfast.
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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: Stephen RichardsonTELEPHONE: (916) -26-4700
LICENSING EVALUATOR NAME: Arvin VillanuevaTELEPHONE: 916-558-2130
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2