342700731-11-8-2024-27-AS-KHOS-DB7K4J-20241120063424

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700731
Report Date: 11/08/2024
Date Signed: 11/08/2024 01:24:52 PM

Unsubstantiated

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
08/05/2024 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20240805133321

FACILITY NAME:	LOVE AND COMFORT ELDERLY CARE		FACILITY NUMBER:	342700731
ADMINISTRATOR:	SHARP, KAYDIA		FACILITY TYPE:	740
ADDRESS:	6532 RANCHO GRANDE WAY		TELEPHONE:	(916) 594-9378
CITY:	SACRAMNETO	STATE: CA	ZIP CODE:	95828
CAPACITY:	6	CENSUS: 4	DATE:	11/08/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Delova Boswell		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Neglect/Lack of Supervision:
1) Licensee does not ensure that equipment shall be provided in the facility that accommodates physically handicapped resident(s) according to their needs.
2)Staff do not ensure that residents in care are provided with food that is of good quality.
3)Staff did not ensure that resident was provided services as necessary.
Personal Rights:
1) Staff verbally abused resident in care.
2) Staff handled resident in a rough manner while in care.
3) Staff yelled at resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to the Love and Comfort Elderly Care RCFE on 11/8/24 at 10:00am to conclude the investigation of the above allegations and to deliver the findings. LPA Gould met with staff, Delova Boswell and together discussed the investigation details.

Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. LPA attempted to contact the reporting party via email and phone with no response. LPA conducted interviews with two staff members who all denied the allegations above. LPA observed fresh food prepared for residents and a plentiful supply of fresh fruits and vegetables LPA also observed staff members cleaning with appropriate gloves and PPE. LPA conducted interviews with four of four residents in place who also denied all the above allegations.
Report Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024

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 5

Control Number 27-AS-20240805133321

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: 11/08/2024

NARRATIVE

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One of the residents could not be interviewed due to their medical diagnosis. None of the residents interviewed corroborated any of the above allegations and all provided statements that the facility os overall positive, staff do a good job of meeting resident needs and residents are treated with kindness and respect. Residents interviewed denied being verbally abused or handled in a rough manner. Residents interviewed also denied that staff do not assist the residents with ADLs and provided statements that staff respond in a timely manner.

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 Neglect/lack of supervision and Personal Rights 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 Licensee. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

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
08/05/2024 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20240805133321

FACILITY NAME:	LOVE AND COMFORT ELDERLY CARE		FACILITY NUMBER:	342700731
ADMINISTRATOR:	SHARP, KAYDIA		FACILITY TYPE:	740
ADDRESS:	6532 RANCHO GRANDE WAY		TELEPHONE:	(916) 594-9378
CITY:	SACRAMNETO	STATE: CA	ZIP CODE:	95828
CAPACITY:	6	CENSUS: 4	DATE:	11/08/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Delova Boswell		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Personal Rights:
1) Staff members engaged in inappropriate activity in the presence of resident in care.
2) Staff stole resident in care's personal belongings.
Neglect/Lack of Supervision:
1) Staff do not ensure that resident's diapering needs are met while in care.
2) Staff do not respond to residents' requests for assistance in a timely manner while in care.
3) Staff do not follow proper sanitation protocols.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024

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 5

Control Number 27-AS-20240805133321

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: 11/08/2024

NARRATIVE

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One of the residents could not be interviewed due to their medical diagnosis. None of the residents interviewed corroborated any of the above allegations and all provided statements that the facility os overall positive, staff do a good job of meeting resident needs and residents are treated with kindness and respect. Residents interviewed denied being verbally abused or handled in a rough manner. Residents interviewed also denied that staff do not assist the residents with ADLs and provided statements that staff respond in a timely manner. Residents interviewed also denied any items being stolen or removed by staff from the home. LPA contacted service coordinator for alleged victim who confirmed belongings were picked up from the facility after resident was sent to the hospital and did not return.

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 Neglect/lack of supervision and Personal Rights 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 Licensee. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
08/05/2024 and conducted by Evaluator Kevin Gould

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240805133321

FACILITY NAME:	LOVE AND COMFORT ELDERLY CARE		FACILITY NUMBER:	342700731
ADMINISTRATOR:	SHARP, KAYDIA		FACILITY TYPE:	740
ADDRESS:	6532 RANCHO GRANDE WAY		TELEPHONE:	(916) 594-9378
CITY:	SACRAMNETO	STATE: CA	ZIP CODE:	95828
CAPACITY:	6	CENSUS: 4	DATE:	11/08/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Delova Boswell		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Physical Plant: Licensee does not ensure that residents have a means to call for assistance while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to the Love and Comfort Elderly Care RCFE on 11/8/24 at 10:00am to conclude the investigation of the above allegations and to deliver the findings. LPA Gould met with staff, Delova Boswell and together discussed the investigation details.

Based on LPA observations and title 22 regulations, the facility does not meet the capacity of 16 residents or multiple structures or levels to meet the requirements to have a signal system.

The Department has investigated the complaint alleging Physical Plant. Based on the investigative interviews, record reviews and other supportive evidence, the complaint is determined to be unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. The Complaint has been dismissed. There are no deficiencies cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff and a copy of this report was left at the facility.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 5 of 5