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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700731
Report Date: 09/05/2024
Date Signed: 09/05/2024 03:13:37 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
09/03/2024 and conducted by Evaluator Kevin Gould
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240903153829
FACILITY NAME:LOVE AND COMFORT ELDERLY CAREFACILITY NUMBER:
342700731
ADMINISTRATOR:SHARP, KAYDIAFACILITY TYPE:
740
ADDRESS:6532 RANCHO GRANDE WAYTELEPHONE:
(916) 594-9378
CITY:SACRAMNETOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 4DATE:
09/05/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Isikeli TuikentatubaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Personal Rights:
1) Facility locks kitchen at night.
2) facility not providing resident with privacy.
3) facility is not respecting resident's personal rights.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kevin Gould and department representative, Shariff Osman conducted an unannounced complaint inspection at Love and comfort Elderly Care RCFE on 9/5/24 at 9:00am to inform the licensee of complaint allegation mentioned above and to deliver findings.

During this investigation LPA Gould interviewed R1, R2, R3 and S1 (See confidential name list LIC-811 dated 9/5/24). Based on the interviews and statements obtained during the investigation process, the allegations are substantiated. S1 and two residents interviewed corroborated the allegation that the facility kitchen, living room and back yard access are locked to residents overnight by placing a door from the garage in the doorframe and securing it baring residents from a significant portion of the home. R1 confirmed that they utilize a bedside commode in their room and have at times shared a room with another resident. R1 had to utilize a bedside commode in a shared room and would often be walked in on by former resident/roommate and would feel uncomfortable toileting in a shared room. Report Continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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 6
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
09/03/2024 and conducted by Evaluator Kevin Gould
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240903153829

FACILITY NAME:LOVE AND COMFORT ELDERLY CAREFACILITY NUMBER:
342700731
ADMINISTRATOR:SHARP, KAYDIAFACILITY TYPE:
740
ADDRESS:6532 RANCHO GRANDE WAYTELEPHONE:
(916) 594-9378
CITY:SACRAMNETOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 4DATE:
09/05/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Isikeli TuikentatubaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
Level of Care: facility accepted a resident who's needs cannot be met.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kevin Gould and department representative, Shariff Osman conducted an unannounced complaint inspection at Love and comfort Elderly Care RCFE on 9/5/24 at 9:00am to inform the licensee of complaint allegation mentioned above and to deliver findings.

During this investigation LPA Gould interviewed R1, R2, R3 and S1 (See confidential name list LIC-811 dated 9/5/24). Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations because resident chose to toilet indepentently and did not want staff assistance with ADLs. Although the resident is unable to access the bathroom independently, It was R1's decision to refuse staff assistance to use the bathroom and instead prefered the used of a bedside commode as R1 would be able to toilet idenpendently as is resident's preference.

Report Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 27-AS-20240903153829
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: LOVE AND COMFORT ELDERLY CARE
FACILITY NUMBER: 342700731
VISIT DATE: 09/05/2024
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Level of care are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies is cited per California Code of Regulations, TITLE 22.

Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 27-AS-20240903153829
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: LOVE AND COMFORT ELDERLY CARE
FACILITY NUMBER: 342700731
VISIT DATE: 09/05/2024
NARRATIVE
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The facility did not provide a resident who utilizes a bedside commode with substantial privacy for performing all ADLs and as a result did not respect the personal rights of resident in care.

The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegations of Personal Rights are substantiated.

The following deficiencies are cited per California Code of Regulations, TITLE 22.

Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the home.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 27-AS-20240903153829
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: LOVE AND COMFORT ELDERLY CARE
FACILITY NUMBER: 342700731
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/06/2024
Section Cited
CCR
87307(c)
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Personal Accommodations and Services: Individual privacy shall be provided in all toilet, bath and shower areas. This requirement was not met as evidenced by, R1's statements and LPAs observations of R1 sharing a room with another resident with a bedside
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Facility will ensure the privacy for all residents while toileting or performing ADLs at the facility and will submit a written plan of correction ensuring all residents who may utilize a bedside commode will be afforded a private room and privacy when toileting.
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commode present that R1 was not provided privacy when toileting at the facility which poses an immediate health, safety and personal rights risk to residents in care.
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Type A
09/06/2024
Section Cited
CCR
87468.1(a)(1)
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Personal Rights of Residents in All Facilities: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by R1's statements and LPA observations that R1 had a shared room and lacked
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Facility will conduct additional personal rights training for all staff and provide to the department by the POC due date.
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privacy and was not treated with dignity by facility staff and other residents which poses an immediate health, safety and personal rights 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) 214-5136
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20240903153829
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: LOVE AND COMFORT ELDERLY CARE
FACILITY NUMBER: 342700731
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/06/2024
Section Cited
CCR
87468.1(a)(6)
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Personal Rights of Residents in All Facilities: To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house rules, such as locking doors at night to protect residents, or barring windows against
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Facility will provide a written statement that the kitchen will not be locked for any purpose.
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intruders, with permission from the Department. This requirement was not met as evidenced by: Statements by S1 confirming the kitchen is locked overnight and residents to not have access to the kitchen, living room or back yard during overnight hours and are restricted to the bedrooms and hallway that leads to the front door which poses an immediate health, safety and personal rights 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) 214-5136
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6