342700961-11-7-2022-27-AS-SRIN-CL9VRB-20221117153940

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700961
Report Date: 11/07/2022
Date Signed: 11/07/2022 11:36:59 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
09/28/2022 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20220928105107

FACILITY NAME:	COMFORTS OF HOME TREASURE		FACILITY NUMBER:	342700961
ADMINISTRATOR:	KANG, MARIA		FACILITY TYPE:	740
ADDRESS:	6997 TREASURE WAY		TELEPHONE:	(916) 833-1493
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95831
CAPACITY:	6	CENSUS: 5	DATE:	11/07/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jacqueline Chan		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Resident was inappropriately touched while in care
Staff spoke inappropriately to resident in care
Staff hit resident in care
Staff does not ensure that residents are adequately fed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 11/7/22 at 9am to further investigate the allegations and deliver the complaint findings. LPA met with Maria Nolan, Caregiver and Jacqueline Chan, Administrator and stated the purpose of the visit.

Regarding allegation, “Resident was inappropriately touched while in care”, Community Care Licensing conducted interviews which revealed that Resident #1 (R1) provided conflicting information regarding the physical description such as the age, height, and hair color of the perpetrator to include conflicting information regarding the parts of body which was inappropriately touched. A review of R1's Physician Report (LIC602) dated 9/17/22 indicated a diagnosis of Dementia, and Confused/Disoriented. The dates provided did not coincide with the the gender of staff that worked. There was insufficient evidence to substantiate the allegation.

Unfounded

Estimated Days of Completion: 60

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022

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-20220928105107

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: COMFORTS OF HOME TREASURE	FACILITY NUMBER: 342700961
	VISIT DATE: 11/07/2022

NARRATIVE

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Regarding allegation, “Staff spoke inappropriately to resident in care” Community Care Licensing conducted interviews which revealed that R1 provided conflicting information regarding being spoken to by the perpetrator. Staff #1 (S1-S2,S4-S11) all concur that R1 was not spoken to inappropriately in the facility. Resident #2 (R2-R6) may not be credible witnesses for this investigation at this time due to diagnosis of dementia. There was insufficient evidence to substantiate the allegation.

Regarding allegation, “Staff hit resident in care” Community Care Licensing conducted interviews which revealed that R1 provided conflicting information regarding being hit by the perpetrator. Staff #1 (S1-S2,S4-S11) all concur that R1 was not spoken to inappropriately in the facility by staff. Resident #2 (R2-R6) may not be credible witness for this investigation at this time due to diagnosis of dementia. There was insufficient evidence to substantiate the allegation.

Regarding allegation, “Staff does not ensure that residents are adequately fed” On 2/15/22, during a Required 1-year inspection, LPA observed a supply of 2 day perishables and 7 day non-perishables. During todays visit, LPA observed a supply of 2 day perishables and 7 day non-perishables and residents preparing for lunch. Staff #1 (S1-S2,S4-S11) all concur that R1 ate well in the facility. Resident #2 (R2-R6) may not be credible witness for this investigation at this time due to diagnosis of dementia. There was insufficient evidence to substantiate the allegation.

The investigation revealed that there was insufficient evidence to substantiate the allegations.

Based on interviews and documentation, the preponderance of evidence standards has not been met.

“This agency has investigated the complaint alleging, the above-mentioned allegation(s). We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.”

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were cited during this visit. An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022

LIC9099 (FAS) - (06/04)

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