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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700835
Report Date: 07/21/2023
Date Signed: 07/21/2023 04:42:34 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/19/2023 and conducted by Evaluator Michael Bilger
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230119152454
FACILITY NAME:CITY CREEK ASSISTED LIVINGFACILITY NUMBER:
342700835
ADMINISTRATOR:CALEB SUMMERHAYSFACILITY TYPE:
740
ADDRESS:6254 66TH AVENUETELEPHONE:
(916) 393-2324
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:121CENSUS: 106DATE:
07/21/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Caleb SummerhaysTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff preventing resident from receiving telephone calls
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7-21-23 at 3:00pm, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived unannounced to continue the investigation for the allegation noted above. LPAs met with Administrator Caleb Summerhays and explained the purpose of the visit. During the investigation for this allegation, LPAs conducted interviews which included three staff members and 3 residents in care. Based on interviews conducted, it was determined that Resident1 (R1) was receiving phone calls, however, misplaced phone in the process as well. It was further determined through interviews that residents in care are able to receive and make phone calls sufficiently. Additionally, based on interview and facility observation conducted on 7-21-23, it was determined residents in care receive phone calls via communication between receptionist and other staff members.

As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. An exit interview was conducted with Caleb Summerhays and a copy of this report was left with Caleb. Appeal rights provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
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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