342700835-5-6-2025-27-AS-KHOS-DGPHWQ-20250515063355

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700835
Report Date: 05/06/2025
Date Signed: 05/06/2025 10:01:09 AM

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
03/17/2025 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20250317103239

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: 110	DATE:	05/06/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Caleb Summerhays and Katelyn Flores		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Staff are not ensuring facility kitchen is clean and sanitized
Staff are not following proper food sanitation and safety practices
Staff are not meeting residents’ dietary needs
Staff are not properly addressing pests in the facility

INVESTIGATION FINDINGS:

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On 05/05/25 Licensing Program Analysts (LPAs) Pang Lee and Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPAs met with Administrator Caleb Summerhays and Health Services Director Katelyn Flores and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is110.

It was alleged that facility staff are not ensuring facility kitchen is clean and sanitized, staff are not following proper food sanitation and safety practices and staff are not properly addressing pests in the facility. The investigation included direct observations, a review of facility records, and interviews with both facility staff and residents. LPA Lee conducted facility inspections on 03/18/25, 04/01/25, and 05/02/25. During these visits, the dining area was consistently observed to be clean and well-maintained. LPA Lee inspected the walk-in freezer, which was operating at the appropriate temperature of 0°F.
All opened food items were properly labeled with preparation and expiration dates, and all expiration dates were current. LPA Lee also observed kitchen staff preparing meals while wearing gloves and hairnets. The kitchen area appeared clean and sanitary, with no evidence of pest activity noted during any of the visits.
Continued LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

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-20250317103239

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: 05/06/2025

NARRATIVE

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According to the kitchen cleaning schedule, daily cleaning is conducted, and staff are required to initial the log upon completion. A review of facility records confirmed an active pest control contract with Official Pest Prevention. The facility receives bi-monthly interior and exterior treatments. Invoices reviewed from 01/04/24 to the present detail the services provided, including target pests and treatment dates. Interviews were conducted with 9 out of 9 residents. All residents reported that the dining area is clean and that they have no concerns regarding kitchen or dining room sanitation. All nine residents also confirmed that kitchen staff consistently wear gloves and hairnets when serving food, both in the dining room and during in-room meal deliveries. Seven of the nine residents reported not seeing any roaches, although a few mentioned seeing spiders in their rooms. However, 7 out of 9 residents expressed dissatisfaction with the food quality and felt that their dietary preferences were not being met. Interviews with 5 facility staff members were conducted, and all denied the allegations.

It was alleged that staff were not meeting residents’ dietary needs. This investigation consists of observations, interviews with staff and residents and a review of facility records. LPA Lee visited the facility on 03/18/25, 04/01/25, and 05/02/25. During these visits, LPA observed kitchen staff placing dietary slips on meal trays to ensure that residents with special dietary requirements received appropriate meals when being deliver to residents in their room. Additionally, residents with special diets were observed being served first in the dining room. LPA Lee interviewed 7 out of 9 residents, all of whom expressed no concerns regarding the staff’s not meeting dietary needs and stated that they don’t like the food being served to them. Furthermore, all 5 staff members interviewed denied the allegations. Records review revealed that when Med Techs receive diet orders signed by the residents’ physicians, the Med Techs then will complete a dietary communication form and provide it to the kitchen supervisor, who then updates the dietary information on the kitchen board. This board lists all residents with specific dietary needs to ensure that all kitchen staff are aware of the residents’ dietary needs. Moreover, a copy of the diet type report and signed order is also placed in the Health Services Director’s (HSD) box for updating the Point Click Care (PCC) portal. The HSD is responsible for updating the PCC portal with any changes to dietary orders. As an additional measure, kitchen staff follow up with the HSD monthly to confirm the accuracy of dietary order lists and ensure compliance with residents’ dietary requirements.
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.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC9099 (FAS) - (06/04)

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