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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700886
Report Date: 09/16/2024
Date Signed: 09/16/2024 04:17:48 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/19/2024 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240819163942
FACILITY NAME:GARDENS AT LAGUNA SPRINGS MEMORY CARE, THEFACILITY NUMBER:
342700886
ADMINISTRATOR:RAMIREZ, GUADALUPEFACILITY TYPE:
740
ADDRESS:9750 LAGUNA SPRINGS DRIVETELEPHONE:
(916) 667-3167
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:70CENSUS: 39DATE:
09/16/2024
UNANNOUNCEDTIME BEGAN:
02:59 PM
MET WITH:Guadalupe RamirezTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff does not ensure that resident's room is free from pests.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a complaint investigation and to deliver findings. LPA Valerio met with Administrator Guadalupe Ramirez, and explained the purpose of the visit.

The investigation consisted of observations of the facility, records review of facility files, and interviews with the Reporting Party, residents, and staff.

According to the RP, the RP visits regularly and states the facility has an ant issue. R1 has a cat and the ants are attracted to the cat food. The RP was visiting R1 one day and decided to go check on the room, which is when RP found ants all over the bed. RP reported that the facility attempted to address the issue; however, the RP is concerned that ants were on the bed and staff did not noticed.

Continues on LIC 9099 - C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
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 2
Control Number 27-AS-20240819163942
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GARDENS AT LAGUNA SPRINGS MEMORY CARE, THE
FACILITY NUMBER: 342700886
VISIT DATE: 09/16/2024
NARRATIVE
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...Continued from LIC 9099
On 08/23/2024, the Local Ombudsman conducted an announced visit to the facility. It was reported that when they visited, the room was spotless and free from pest. On 08/26/2024, LPA Valerio observed the facility and R1's bedroom. LPA inspected common areas, hallways, dining tables, and activity area. LPA inspected R1's bed, pillow, corners of the bedroom, around the cat food, and in the bathroom area. Pests were not observed during the visit. LPA took pictures for future reference.

On 08/26/2024, LPA Valerio reviewed the video submitted to the Regional Office. The video captures a pillow on a Resident 1 (R1) bed. The pillow is covered with black ants, small to medium sized ants. There are some that are dead on the pillow and some that are crawling on the pillow along with a few on the bed sheets.

LPA Valerio attempted to interview the resident in care. However, due to communication barriers, the interview was unsuccessful. Residents did not appear to be in distress and were being supervised by staff members.

LPA Valerio interview Staff 1 (S1). S1 reported that "they do have ants; however, staff do a good job about cleaning up after the residents. This place is in the middle of a field, so I assume this was the ant's home before we got here… There is not a time where we do not try to address the issue." According to an interview with Staff 2 (S2),  S2 stated that they have had pest control services come every month, but they have also increased their services within the last month. S2 provided invoices from June, July, August, and September. S2 stated that they comes and check all the rooms and outside of the facility. They put the sprays and everything. Staff do constant check of the rooms and when it is known there are pest, they say it on their walkie talkie. They assess to see if the resident has any on them, if they are in the room. They shower them, check for any food, and clean the room.

According to Pest Control Invoices, the facility has a monthly pest service. On 05/29/24, 06/18/24, 08/09/24, pest control services provided normal service in addition to treats for the ant issue.

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 (CCR) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of report was left at the facility.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2