342700594-5-24-2022-27-AS-KHOS-CF8J6K-20220609064628

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700594
Report Date: 05/23/2022
Date Signed: 05/24/2022 10:09:53 AM

Unsubstantiated

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
04/21/2022 and conducted by Evaluator Avelina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220421162601

FACILITY NAME:	WOODLAKE, THE		FACILITY NUMBER:	342700594
ADMINISTRATOR:	SWEARINGEN,MICHELLE		FACILITY TYPE:	740
ADDRESS:	1445 EXPO PARKWAY		TELEPHONE:	(916) 604-3780
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95815
CAPACITY:	144	CENSUS: 86	DATE:	05/23/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Michelle Swearingen		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Residents' brief needs are not met
Staff force residents into the shower fully dressed
Staff do not change resident's clothing at bed time
Inadequate food service
Residents are not offered daily activities

INVESTIGATION FINDINGS:

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

On 05/24/2022 at 10:00 am, Licensing Program Analysts (LPAs) Anthony Tuck and Avelina Martinez arrived at the facility unannounced to deliver complaint findings. LPA Martinez met with Michelle Swearingen during today’s visit.

Throughout the course of this investigation, LPA Martinez conducted facility staff interviews in the memory care unit. Four staff reported there were no issues in providing care in regards to brief changes, showering with clothes on, and changing residents' clothing . Moreover, LPA Martinez interviewed 3 residents, and all 3 residents reported no issues or concerns for this facility. LPA also interviewed witness 1(W1) and witness 2 (W2), and W1 and W2 reported having no issues or concerns about the facility's care and supervision services. Additionally, LPA Martinez observed residents in the memory care unit during facility visits, and the residents appeared to be wearing clean clothing and appeared to be sanitary. During the facility tours, LPA Martinez did not smell any foul odors from the facility or residents.

Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

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 2

Control Number 27-AS-20220421162601

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: WOODLAKE, THE	FACILITY NUMBER: 342700594
	VISIT DATE: 05/23/2022

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

Furthermore, three residents did not have complaints in regards to the food service. LPA Martinez interviewed kitchen staff (K1), and toured the kitchen facility with (K1). LPA Martinez requested to observe plate servings for the memory care unit. LPA Martinez was informed some residents in the memory care unit are given double portions due to diet plans. LPA Martinez also reviewed the resident special diet plan list with K1. LPA Martinez was also informed residents will be given additional meal servings if requested at no additional costs. LPA Martinez did not find a substantial preponderance of evidence to state the facility was providing inadequate food service. LPA Martinez observed activities in memory care unit while visiting the facility. LPA Martinez was also informed by staff activities were being conducted by care givers during their shifts.

Due to the above noted information, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, and therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was given to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2