342700886-5-10-2023-27-AS-KHOS-CSCGZZ-20230531054757

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700886
Report Date: 05/10/2023
Date Signed: 05/10/2023 10:14:05 AM

Unfounded

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
02/23/2023 and conducted by Evaluator Tung Truong

COMPLAINT CONTROL NUMBER: 27-AS-20230223142712

FACILITY NAME:	GARDENS AT LAGUNA SPRINGS MEMORY CARE, THE		FACILITY NUMBER:	342700886
ADMINISTRATOR:	RAMIREZ, GUADALUPE		FACILITY TYPE:	740
ADDRESS:	9750 LAGUNA SPRINGS DRIVE		TELEPHONE:	(916) 667-3167
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95757
CAPACITY:	70	CENSUS: 33	DATE:	05/10/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Steve Sarine		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Resident sustained injuries while in care.
Resident suffered falls while in care.
Staff over medicate resident.
Resident is left soiled for a long period of time.
Staff are not administering medications to resident.

INVESTIGATION FINDINGS:

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On 5/10/23, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit to this facility to conclude the investigation of the above allegation and to deliver the findings. LPA met with Regional Director of Operations Steve Sarine and explained the purpose of today’s visit.

Throughout the course of the investigation, LPA conducted interviews and reviewed records. Based on interviews and records review, LPA Truong has determined that the allegations are unfounded. No supporting information to the allegations was discovered. Complaint is deemed to be unfounded at this time.

As a result of this investigation, LPA finds the allegations above to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis.

An exit interview was conducted, and a copy of this report was left at the facility.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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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