342700835-2-20-2024-27-AS-KHOS-D8HQQZ-20240826122306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700835
Report Date: 02/20/2024
Date Signed: 02/20/2024 03:22:37 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
09/14/2023 and conducted by Evaluator Jamie Ivey-Canady

COMPLAINT CONTROL NUMBER: 27-AS-20230914115212

FACILITY NAME:	CITY CREEK ASSISTED LIVING		FACILITY NUMBER:	342700835
ADMINISTRATOR:	CALEB SUMMERHAYS		FACILITY TYPE:	740
ADDRESS:	6254 66TH AVENUE		TELEPHONE:	(916) 393-2324
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	121	CENSUS: 112	DATE:	02/20/2024
		UNANNOUNCED	TIME BEGAN:	12:46 PM
MET WITH:	Melina Dearing		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Illegal drug activity on the premises
Staff did not provide a safe and comfortable environment for residents
Staff did not provide toiletries to residents
Staff did not provide privacy to residents
Untrained staff

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jamie Ivey Canady arrived at the facility unannounced to deliver complaint findings regarding current complaint allegations . LPA Ivey Canady explained the purpose of the visit and was met by Melina Dearing.

The Department has determined the following as it relates to the complaint allegations: Illegal drug activit on the premises, Staff did not provide a safe and comfortable environment for residents, Staff did not provide toiletries to residents, Staff did not provide privacy to residents and Untrained staff

Continues on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Jamie Ivey-Canady	TELEPHONE: (916) 862-5693
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

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-20230914115212

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: CITY CREEK ASSISTED LIVING	FACILITY NUMBER: 342700835
	VISIT DATE: 02/20/2024

NARRATIVE

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On 2/16/2024 LPA Jamie Ivey Canady conducted an investigation regarding current facility allegations. It was learned the facility has designated an area in the facility between hall 200 and hall 300 for residents that have medical prescriptions to smoke medical marijuana. Based on facility record review, all facility residents that smoke medical marijuana have physician prescriptions and the prescriptions are documented in resident facility files. According to interviews with facility staff, the only residents that smoke medical marijuana in the designated areas are residents with prescriptions. Therefore the allegation Illegal drug activity on the premises is unsubstantiated. An unsubstantiated finding means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

On 2/16/2024 LPA Jamie Ivey Canady conducted an investigation regarding current facility allegations. According to facility record review, all visitors are asked to sign in at the front reception all area. For resident safety, doors are locked at 8pm when the front desk facility staff leave for the day. Residents can come in and out of the facility using the key pad and all residents have a passcode to get in and out of the facility. There is also a doorbell at the front of the facility that also rings in the MedTech room that alerts staff that someone is at the door. The facility is currently in the process of renovating resident rooms and are at 50% completion. It has taken approximately 2 working days for each room to be renovated. All resident belongings are transported into temporary accommodations while resident rooms are being completed. And transported back into the resident rooms after completion of the renovation. Residents have a variety of blankets and comforters in each room. Each resident has a regular blanket and comforter that is provided by the facility. Residents also are provided with clean linens on each resident shower day on average of twice a week. Based on facility staff interviews and facility resident interviews, the allegation Staff did not provide a safe and comfortable environment for residents is unsubstantiated. An unsubstantiated finding means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Cont 9099C

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Jamie Ivey-Canady	TELEPHONE: (916) 862-5693
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230914115212

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: CITY CREEK ASSISTED LIVING	FACILITY NUMBER: 342700835
	VISIT DATE: 02/20/2024

NARRATIVE

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On 2/16/2024 Licensing Program Analyst (LPA) Jamie Ivey Canady conducted an investigation regarding current facility allegations. According to facility staff interviews, toiletries for facility residents are purchased on a monthly basis. According to Staff and resident interviews, there are plenty supplies of toothbrushes and toothpaste in the facility and the facility is well stocked with other toiletries as well. On 2/16/2024, LPA toured the facility and observed resident bathrooms to have all Title 22 regulated items as required. Therefore the allegation Staff did not provide toiletries to residents is unsubstantiated. An unsubstantiated finding means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

On 2/16/2024 Licensing Program Analyst (LPA) Jamie Ivey Canady conducted an investigation regarding current facility allegations. Based on interviews with facility staff, many of the residents have shared rooms and during bathing time for residents, facility staff respect their privacy regarding in and out of the shower. The facility provides towels and linens to cover them and when it is necessary to close doors the staff closes the doors. According to staff interviews, additional linens were purchased for the facility residents in the past 30 days. During LPA facility tour, LPA observed there to be blinds or curtains in all facility resident rooms for privacy. Based on interviews with facility residents, there are no complaints regarding not having privacy in the facility. Therefore the allegation, Staff did not provide privacy to residents is unsubstantiated. An unsubstantiated finding means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

On 2/16/2024 and 2/20/2024 Licensing Program Analyst (LPA) Jamie Ivey Canady conducted an investigation regarding current facility allegations. LPA requested, received and reviewed facility MedTech training documents for the months of 8/2023 and 9/2023. Based on facility record review, the facility is conducting MedTech training in accordance with Title 22 regulations. Based on record review, 9 Sections of MedTech training for new facility MedTech staff were conducted over a 3 day span from 8/29/2023 - 8/31/2023. Based on interviews with facility residents, there has been no experiences with MedTech staff being untrained and not knowing how to carry out their duties properly. Therefore the allegation "Untrained Staff' Is unsubstantiated. An unsubstantiated finding means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No Deficiencies have been cited during today's visit.
Exit interview conducted and copy of today's report was given to facility staff Melina Dearing.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Jamie Ivey-Canady	TELEPHONE: (916) 862-5693
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

LIC9099 (FAS) - (06/04)

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