342700828-8-14-2024-27-AS-KHOS-D8QPC2-20240902111114

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700828
Report Date: 08/14/2024
Date Signed: 08/14/2024 01:08:14 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
05/02/2024 and conducted by Evaluator Arvin Villanueva

COMPLAINT CONTROL NUMBER: 27-AS-20240502104559

FACILITY NAME:	LOVE AND SERENITY OF ELK GROVE III		FACILITY NUMBER:	342700828
ADMINISTRATOR:	CASTRO, BIANCA		FACILITY TYPE:	740
ADDRESS:	9442 MAZATLAN WAY		TELEPHONE:	(916) 585-5483
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	6	CENSUS: 5	DATE:	08/14/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Bianca Castro		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Staff are not ensuring that resident(s) receive the quality and quantity of food/liquid necessary to meet resident(s) needs while in care.

INVESTIGATION FINDINGS:

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On 8/14/24, at 10am, Licensing Program Analyst (LPA) arrived at this facility unannounced to conduct a follow up complaint visit regarding the allegation noted above. LPA met with Bianca Castro and stated the purpose of the visit. Present during today's visit were 5 residents in care with 1 staff on duty (S1).

This investigation consisted of observatiosn and interviews of both facility staff members and residents in care.
Through staff interviews details the facility's approach to food services noting that meals are tailored to meet individual residents' dietary needs. For instance, meals are adjusted for diabetic residents and snacks are provided between meals (around 10:30 AM and 2:00 PM). Staff (S1) emphasized that food preparation is designed to align with residents' preferences and dietary requirements. S1 mentioned that staff prepares surplus food each meal to accommodate additional requests from residents. Although S1 was uncertain about the use of a nutritionist, the general practice of meal preparation was described as responsive to residents' needs.
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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Arvin Villanueva	TELEPHONE: 916-208-0023
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

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-20240502104559

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 SERENITY OF ELK GROVE III	FACILITY NUMBER: 342700828
	VISIT DATE: 08/14/2024

NARRATIVE

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Additionally, resident interviews affirmed their satisfaction with the food provided. One resident stated the food as nutritious.

Inspection of food supply: On several visits on 8/14/24, 7/18/24, and 5/9/24, conducted by this LPA revealed facility to have a well-stocked refrigerator and freezer containing different vegetables, meats, breakfast items, fruits, eggs, milk, juices and snacks. Inspection of their pantry include Included non-perishable items such as canned foods, boxed pastas, cereals, and rice, as well as fresh potatoes and onions.

Meal observations: LPA observed the meal preparations on different visits. One observation where ground meat and a variety of fresh vegetables were being cooked. During the same visit, residents' lunch was observed with a balanced meal including a bologna sandwich, salad, chips, and juice. Residents (R4 and R5) expressed satisfaction with the food quality, describing it as nutritious and enjoyable. Also during today's visit, LPA observed S1 prepared chicken burger for residents' lunch along with chips and pudding and choice of beverages.

Based on interviews, observations of food preparation and supply, and feedback from residents, there was not preponderance of evidence to substantiate the allegation that staff do not ensure that residents receive adequate quality and quantity of food and liquid. The facility appears to be meeting residents' dietary needs, with appropriate food supplies and positive feedback from residents. However, LPA is unable to determine if this practice is sustained daily, therefore, the allegation is deemed UNSUBSTANTIATED.

Note that a finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with S1 and a copy of this report was provided.

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SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Arvin Villanueva	TELEPHONE: 916-208-0023
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

LIC9099 (FAS) - (06/04)

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