<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700731
Report Date: 03/07/2025
Date Signed: 03/07/2025 12:09:46 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
02/28/2025 and conducted by Evaluator Kevin Gould
COMPLAINT CONTROL NUMBER: 27-AS-20250228153401
FACILITY NAME:LOVE AND COMFORT ELDERLY CAREFACILITY NUMBER:
342700731
ADMINISTRATOR:CLEOPATRA GARDINERFACILITY TYPE:
740
ADDRESS:6532 RANCHO GRANDE WAYTELEPHONE:
(916) 594-9378
CITY:SACRAMNETOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 5DATE:
03/07/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ratu VunimatanaTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
1) Staff do not keep adequate record keeping.
2) Staff did not provide resident medication as prescribed.
3) Staff are not properly storing residents’ medications.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Kevin Gould and Cynthia Tamayo conducted an unannounced complaint inspection at Love and Comfort Elderly Care RCFE on 3/7/25 at 9:00am to inform the licensee of complaint allegations mentioned above. LPAs met with the licensee and together discussed the purpose of todays inspection.

During this investigation LPA Gould interviewed S1 and R1 (See confidential name list LIC-811 dated 3/7/25) LPA Gould conducted file review for R1 and reviewed R1's medication administration records and centrally stored medications. Based on the interviews and documents reviewed during the investigation process, the allegations are substantiated. LPA observed medication bottle Sodium Bicarbonate with no current medications and no refills currently at the home. LPA observed this medications to have been given above the normal dose as LPA observed am and noon medications already signed off and administered to resident ahead of the time prescribed by R1's physician. Report continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
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
Control Number 27-AS-20250228153401
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: 03/07/2025
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
LPA observed another prescription filled on 9/16/24 with more medications present that should be based on R1's admission date and time at the facility, the number of pills remaining in the container is more than should be present at the facility if resident had been receiving their medication as prescribed. medication still has 3 refills left. LPAs also observed unknown pills/medications, not stored correctly as they were not stored in any container and were just in the medication storage box for resident.

The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation of Medications is substantiated.

The following deficiency 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 home.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 27-AS-20250228153401
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: 03/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/10/2025
Section Cited
CCR
87465(a)(1)
1
2
3
4
5
6
7
Incidental Medical and Dental Care: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by, LPAs review of R1's medical administration records
1
2
3
4
5
6
7
Licensee has agreed to conduct medication administration training for all staff members who assist resident's with medications. The training must be provided by a licensed to work as a health care provider in California.
8
9
10
11
12
13
14
which showed R1 was already given his noon time medications and were marked off as administered to the resident although it was too early for the resident to be administered the medication which poses an immediate health, safety or personal rights risk to residents in care.
8
9
10
11
12
13
14
Type A
03/10/2025
Section Cited
CCR
87465(c)(2)
1
2
3
4
5
6
7
Incidental Medical and Dental Care:
Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by LPAs observations that the number of medications per one medication filled
1
2
3
4
5
6
7
licensee has agreed to conduct medication administration training for all staff members who assist resident's with medications. The training must be provided by a licensed to work as a health care provider in California.
8
9
10
11
12
13
14
9/16/24 and still has 3 remaining refills are not being administered to the resident per the physician's orders which poses an immediate health safety and personal rights risk to residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20250228153401
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: 03/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/10/2025
Section Cited
CCR
87465(h)(5)
1
2
3
4
5
6
7
Incidental Medical and Dental Care: Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by LPA observations of
1
2
3
4
5
6
7
licensee has agreed to conduct medication administration training for all staff members who assist resident's with medications. The training must be provided by a licensed to work as a health care provider in California.
8
9
10
11
12
13
14
unknown medications in the resident medication box stored without any container and floating freely in the medication box which poses an immediate health, safety and personal rights risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6