342700877-5-17-2023-59-AS-MSEY-CRXNLN-20230518103346

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700877
Report Date: 05/17/2023
Date Signed: 05/17/2023 03:50:47 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
03/28/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230328175451

FACILITY NAME:	ROBERT CREEK VILLA I		FACILITY NUMBER:	342700877
ADMINISTRATOR:	SBINGU, ADINA		FACILITY TYPE:	740
ADDRESS:	8135 ROBERT CREEK VILLA COURT		TELEPHONE:	(916) 745-4230
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 6	DATE:	05/17/2023
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Adina Sbingu, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Residents are chemically restrained with medication
Facility staff not fingerprint-cleared
Staff are using drugs while on duty
Facility staff are abusing residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived at the facility unannounced to conclude the complaint investigation for above allegations. LPA met with Administrator, Adina Sbingu, and explained the purpose of the visit.

During today's investigation, LPA interviewed Administrator, (1) staff and (4) residents and confirmed photo ID's for multiple staff. During the investigation, medications were reviewed for (5) residents on 4/4/23. Staffing schedules were also reviewed. The results of the investigation are as follows;

Allegation: Residents are chemically restrained with medication. Complaint alleges that staff are giving residents medication to keep them sleeping.

Interviews with Administrator and staff indicated that residents are only given medications for which there is a prescribed physician order.

***cont on 9099C(1)..

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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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Control Number 59-AS-20230328175451

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: ROBERT CREEK VILLA I	FACILITY NUMBER: 342700877
	VISIT DATE: 05/17/2023

NARRATIVE

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9099C(1).. Administrator stated that residents are "never chemically restrained". and no residents take cough syrup or the medication, Trazadoen, which commonly causes sleepiness. Medications were reviewed for (5) residents on 4/4/23, and it was determined that all medications are being administered as ordered with were no discrepancies found. (4) residents interviewed stated staff gives them ordered medications only, and most residents are awake and up for breakfast and eat together in the common area.
Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Allegation: Facility staff not fingerprint-cleared. Complaint alleges that some staff are undocumented and are not finger-print cleared.LPA reviewed staffing records and schedules and confirmed that all staff are finger-print cleared and associated to the facility. In addition, LPA confirmed multiple staff's identity from a photo ID or passport. Administrator confirmed that all staff hired are authorized to work in the facility.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Allegation: Staff are using drugs while on duty. Complaint alleges that staff are using drugs while on duty. Administrator and staff interviewed insisted that no staff are under the influence of alcohol or drug that would prevent them from providing care and supervision to the residents. Administrator commented that there is only alcohol-free wine on site and served at the facility. All residents interviewed indicated that staff provide good care and attend to them promptly when assistance is needed.. Residents stated that staff are always alert and awake to do their jobs and no staff has ever been observed to be under the influence of any drug or alcohol at the facility.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

cont on 9099C(2)..

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 59-AS-20230328175451

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: ROBERT CREEK VILLA I	FACILITY NUMBER: 342700877
	VISIT DATE: 05/17/2023

NARRATIVE

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9099C(2).. Allegation: Facility staff are abusing residents. Complaint alleges that staff are abusing residents with no specific details provided.

Administrator and staff interviewed stated that no staff has ever been observed to abuse any resident in any way. Administrator stated there has never been any abuse at any time and caregivers provide exception care to residents at all times.

All residents interviewed stated that they have never observed any abuse from staff and all staff provide excellent care. LPA's observed staff to be competently assisting residents and able to perform their jobs on 4/4//23 and in October and November, 2022.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

All allegations were determined to be unfounded.

There are deficiencies cited and the complaint is being dismissed.

Exit interview. Copy of report provided to Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC9099 (FAS) - (06/04)

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