342700886-10-30-2023-27-AS-KHOS-CX5RKT-20231031130604

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700886
Report Date: 10/30/2023
Date Signed: 10/30/2023 11:31:06 AM

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
07/10/2023 and conducted by Evaluator Tung Truong

COMPLAINT CONTROL NUMBER: 27-AS-20230710111426

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: 35	DATE:	10/30/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Barbara Rose		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff do not ensure pull cords are accessible to residents in care
Facility staff are not properly addressing pest infestation in facility
Facility staff prevent residents from accessing food
Facility staff mismanage residents medication
Facility staff are not properly supervising residents who are a fall risk
Facility staff speak inappropriately to residents in care
Facility staff are not trained appropriately to provide care to residents
Facility staff not safe guarding residents’ belongings

INVESTIGATION FINDINGS:

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On 10/25/23, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced facility visit to complete and deliver findings for a complaint investigation received on 7/10/23. LPA met with Director of Resident Services Barbara Rose and discussed the conclusion for complaint and the findings.

Throughout the course of the investigation, LPA toured the facility, conducted staff and resident interviews and reviewed records. Based on observations, records review, and staff and resident interviews, there is not a preponderance of evidence to substantiate the allegations mentioned above.

Regarding the allegation that staff do not ensure pull cords are accessible to residents in care, it was learned that resident (R1) pulls her cord off the wall daily. Staff stated that they check and fix the cord on a daily basis. LPA observed that the pull cord in R1’s room is accessible and in good repair.

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: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 27-AS-20230710111426

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: 10/30/2023

NARRATIVE

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Regarding the allegation that staff are not safeguarding residents’ belongings, it was determined that there is not a preponderance of evidence to substantiate the allegation. Based on statement obtained, it was learned that facility has encouraged families to lock resident’s valuable upon move-in. Based on staff interviews, staff stated that they will help locate misplaced items and redirect residents if they try to enter a room that is not theirs.

As a result of the investigation, LPA finds the allegations above 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 a copy of the report was provided upon exit.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 27-AS-20230710111426

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: 10/30/2023

NARRATIVE

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Regarding the allegation that staff are not properly addressing pest infestation in facility, it was learned that pest control services were being done monthly and additional days were added to address the pest infestation that was happening in Elk Grove. According to resident interviews, residents stated that they observed some ants in their rooms, but it was treated. LPA conducted a review of the resident rooms and did not observe any pests.

Regarding the allegation that staff prevent residents from accessing food, it was learned that all staff and residents have access to snacks and a variety of food on a daily basis. It was learned that residents do not have access to the kitchen for safety reasons. Based on resident interviews, residents stated that staff will provide snacks and food if they ask.

Regarding the allegation that staff mismanage residents’ medication, there is not a preponderance of evidence to substantiate the allegation. Based on statements obtained, it was learned that medications were provided to residents according to doctor’s order. LPA conducted a medication review and did not observe any discrepancies.

Regarding the allegation that staff are not properly supervising residents who are a fall risk, LPA finds insufficient evidence to substantiate the allegation. Based on statements obtained, it was learned that residents who are at fall risk were closely monitored.

Regarding the allegation that staff speak inappropriately to residents in care, LPA finds insufficient evidence to substantiate the allegation. Based on statements obtained, there was no supporting information found. LPA interviewed staff S1, S1 denied making any inappropriate comments about residents.

Regarding the allegation that staff are not trained appropriately to provide care to residents, LPA reviewed staff files and verified staff training. LPA interviewed staff S2. S2 denied providing any care to residents. S2 stated that they were only redirecting resident while waiting for available caregivers to come and assist.

Continued on 9099-C

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

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