342700886-7-29-2022-27-AS-KHOS-CHDLCQ-20220817083843

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700886
Report Date: 07/29/2022
Date Signed: 07/29/2022 12:40:30 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
04/29/2022 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20220429100622

FACILITY NAME:	GARDENS AT LAGUNA SPRINGS MEMORY CARE, THE		FACILITY NUMBER:	342700886
ADMINISTRATOR:	MARY KEATON		FACILITY TYPE:	740
ADDRESS:	9750 LAGUNA SPRINGS DRIVE		TELEPHONE:	(916) 667-3167
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95757
CAPACITY:	70	CENSUS: 30	DATE:	07/29/2022
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Director of Nursing Nekia Xavier		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff handled resident in a rough manner

Staff yelled at resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived to the facility unannounced to deliver findings on an complaint investigation. LPA Lund explained the reason for the visit to Director of Nursing Nekia Xavier. Census 30.

The Department has determined the following as it relates to the allegations: Staff handled resident in a rough manner and staff yelled at resident

According to an interview with staff 2 (S2), an incident occurred involving resident 1 (R1) and staff 4 (S4). S2 observed S4 handling R1 in a rough manner by lifting R1's arm above R1's head in a 90-degree angle while pulling the arm in a fast and harsh manner. S4 was getting R1 ready for a shower and had to bring R1 from the common area to R1's room. S2 reported that S4 talks really loud to everyone but does not yell.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

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-20220429100622

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: GARDENS AT LAGUNA SPRINGS MEMORY CARE, THE	FACILITY NUMBER: 342700886
	VISIT DATE: 07/29/2022

NARRATIVE

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According to an interview with staff 1 (S1), S1 stated S4 was talked to about the incident. S1 reported that S4 was shocked that it was observed in that way and seemed remorseful. S1 stated the administrator was made aware of the incident, but they did not document the conversations or the incident. S1 stated S4 continued to work after the incident was reported.

According to an interview with S3 (S3), S3 learned of the incident involving S4 a few weeks after it happened. S3 stated S4 is an employee contracted through a 3rd party contractor. S3 reported that S4 was immediately removed from the scheduled after S3 had learned of the situation.

According to an interview with S5, S5 was unaware if any of the allegations were true or happened.

According to records review, R1 is diagnosed with Alzheimer's Disease and receives memory care services from Gardens at Laguna Spring Memory Care. During an interview with R1, R1 was unable to provide information regarding any incidents or staff members.

According to an interview with a family member, the facility staff was observed to be friendly to residents. During visits, staff were not observed to be handling residents in a rough manner or yelling at residents. It was said that the facility is short staff and there are many residents not happy about that.

Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of report was given to Administrator.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

LIC9099 (FAS) - (06/04)

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