342700619-9-8-2023-27-AS-KHOS-CVTVCY-20230919161955

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700619
Report Date: 09/08/2023
Date Signed: 09/08/2023 11:55:07 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
08/24/2023 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230824133745

FACILITY NAME:	YELLOW ORCHID LLC		FACILITY NUMBER:	342700619
ADMINISTRATOR:	BHADE, KIRENDEEP		FACILITY TYPE:	740
ADDRESS:	9470 SEA CLIFF WAY		TELEPHONE:	(916) 432-0685
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	6	CENSUS: 4	DATE:	09/08/2023
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Kirendeep Bhade		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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False statement

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with Kirendeep Bhade and explained the purpose of the visit.

This investigation consisted of interviews with three staff members, a resident, a resident’s friend, two medical center employees, and review of resident records and facility records.

LPA Moleski reviewed a letter of agreement between this facility and a medical center. The agreement was signed by S2 on 4/19/23. The agreement arranged for R1 to be discharged from the medical center and admitted to this facility, with the medical center paying for R1’s residency from 4/24/23 to 6/24/23. The letter of agreement does not make any provisions regarding R1’s placement after that period of time.

[continued on 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

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-20230824133745

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: YELLOW ORCHID LLC	FACILITY NUMBER: 342700619
	VISIT DATE: 09/08/2023

NARRATIVE

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LPA Moleski reviewed a letter written by a medical center representative (M2) discussing payment arrangements for R1 between 6/24/23 and 7/24/23. The letter was signed by S2 on 4/24/23. The letter does not make any provisions regarding R1’s placement after that period of time.

LPA Moleski reviewed R1’s admission agreement. R1 signed the admission agreement on 4/24/23. The admission agreement describes payment arrangements as described in the medical center letter of agreement and the letter written by M2. The admission agreement does not make any provisions regarding R1’s placement after 7/24/23.

LPA Moleski interviewed a friend of R1 (F1). F1 said that, during a conversation with S2 prior to R1’s admission, S2 said R1 would be placed at a medical center after three months if R1 was unable to pay for continued residency.

LPA Moleski interviewed S1-S3. S1 did not have information about the aforementioned conversation. S2 said that, during that conversation, S2 said staff would try to see if the medical center would accept R1 after three months if R1 was unable to pay, but did not make any promises regarding R1’s placement after that period of time. S3 corroborated S2’s narrative.

LPA Moleski interviewed a medical center discharge planner (M1). M1 said there were no arrangements to send R1 back to the medical center, and that R1 was responsible for R1’s future placements.

LPA Moleski interviewed a medical center interim social service director (M2). M2 said S2 contacted M2 to discuss potential future placement at the medical center. M2 said R1 was denied placement as the placement was determined to be not medically necessary.

The department has determined the following as it relates to the allegation of false statement: Based on interviews and record review, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Bhade.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

LIC9099 (FAS) - (06/04)

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