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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700835
Report Date: 05/07/2024
Date Signed: 05/07/2024 03:55:36 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
05/01/2024 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240501155846
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: 113DATE:
05/07/2024
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Caleb Summerhays and Mel Dearing TIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents are exposed to supervisor ill-mannered behavior.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 05/07/2024, Licensing Program Analyst (LPA) Pang Lee conducted an unannounced facility visit to open and closed a complaint investigation LPA Lee met with Administrator Caleb Summerhays and Nurse Mel Dearing and explained the purpose of today's visit. The census is 113.

During today’s visit, LPA Lee toured the facility and observed 9 residents’ bedrooms. LPA Lee also interviewed 9 residents. 8 out of 9 residents denied the allegation and has not witnessed supervisor raising their voices to other staff/Resident Aids. LPA Lee also interviewed 7 facility staff and 5 out of 7 facility staff denied the allegation and has not experienced and witness supervisor being unprofessional and raising their voices at other staff.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed. An exit interview was held, and a copy of the report was provided.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
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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