342700886-6-28-2023-27-AS-KHOS-CTFKZG-20230705082043

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700886
Report Date: 06/28/2023
Date Signed: 06/28/2023 04:25:20 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
03/09/2023 and conducted by Evaluator Tung Truong

COMPLAINT CONTROL NUMBER: 27-AS-20230309133440

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: 34	DATE:	06/28/2023
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Guadalupe Ramirez, Administrator		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Resident sustained a severe head injury due to staff neglect.
Facility does not have enough staff to meet the needs of residents in care.

INVESTIGATION FINDINGS:

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On 6/28/23, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit to this facility to deliver the complaint findings. LPA identified himself and discussed the purpose of the visit and the elements of the allegation(s) with Administrator Guadalupe Ramirez.

Throughout the course of the investigation, the Department conducted interviews and reviewed medical records. Regarding the allegation that resident sustained a severe head injury due to staff neglect, it was learned that on 3/3/2023 resident (R1) fell out of her wheelchair and hit her head and sustained a large cut to her forehead. Based on staff interviews, staff stated R1 was in a reclined position prior to falling out of her wheelchair. Moreover, R1’s facility documents do not indicate that she is a fall risk or that she required certain care in her wheelchair.

Continued on 9099-C

Unsubstantiated

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: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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 27-AS-20230309133440

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: 06/28/2023

NARRATIVE

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Regarding the allegation of facility does not have enough staff to meet the needs of residents in care, LPA did not find sufficient evidence to support the allegation. Based on interviews conducted with residents, 2 out of 3 residents stated that their needs were met and do not feel the facility is short staff. Staff who were interviewed stated that the facility has adequate staffing to meet the needs of the residents.

This Department has investigated the allegations noted above and have found the complaint to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted and copy of report left at facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
03/09/2023 and conducted by Evaluator Tung Truong

COMPLAINT CONTROL NUMBER: 27-AS-20230309133440

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: 34	DATE:	06/28/2023
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Guadalupe Ramirez, Administrator		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Staff are fasifying incident reports.

INVESTIGATION FINDINGS:

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On 6/28/23, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit to this facility to deliver the complaint findings. LPA identified himself and discussed the purpose of the visit and the elements of the allegation(s) with Administrator Guadalupe Ramirez.

Throughout the course of the investigation, LPA conducted interviews and reviewed records. Regarding the allegation that staff are falsifying incident reports, LPA did not find any evidence to support the allegation. Based on staff interviews, staff denied any false reporting or provided false information on facility incident reports.

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: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3