342701093-10-11-2023-27-AS-KHOS-CZ6S7Q-20240104123756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701093
Report Date: 10/11/2023
Date Signed: 10/11/2023 11:20:58 PM

Unfounded

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
10/10/2023 and conducted by Evaluator Kimberly Viarella

COMPLAINT CONTROL NUMBER: 27-AS-20231010100916

FACILITY NAME:	GOLDEN MOMENTS CARE HOME		FACILITY NUMBER:	342701093
ADMINISTRATOR:	ANDERSON-WHITE, MAKAYLA		FACILITY TYPE:	740
ADDRESS:	2651 ARMSTRONG DR		TELEPHONE:	(916) 979-9828
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	6	CENSUS: 6	DATE:	10/11/2023
		UNANNOUNCED	TIME BEGAN:	04:15 PM
MET WITH:	Melissa Stonich		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Employees have not passed their criminal background checks.
Residents incontinent care needs are not being met.
Staff restrain residents.

INVESTIGATION FINDINGS:

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On 10/11/23 Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to close the complaint investigation regarding the above allegations. The LPA identified herself, the purpose of the visit, and asked to speak to the Designated Facility Administrator. The Administrator was home sick and a staff member was identified as her Designee. The LPA met with the Designee and a brief interview followed to review the findings of this investigation.
Based on observations, a records review, as well as interviews, the department has determined the above allegations were UNFOUNDED.
Regarding the first allegation: Employees have not passed their criminal background checks.
The LPA reviewed the staff roster to ensure that all members had received their background clearances. Two individuals were not listed on the LPA's Guardian roster. During the course of the investigation, it was discovered that the two individuals were cleared; they had changed their marital status/names and those had not yet been submitted to Licensing to be updated. This LPA contacted the Administrator and provided instructions on the process.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

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-20231010100916

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: GOLDEN MOMENTS CARE HOME	FACILITY NUMBER: 342701093
	VISIT DATE: 10/11/2023

NARRATIVE

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Regarding the second allegation: Residents incontinent care needs are not being met.
On the morning of 11/10/23, this LPA inspected bathroom trashcans to ascertain whether residents were being double-briefed. This LPA found no evidence that staff were layering adult briefs on residents. During a previous visit, this LPA observed carestaff escorting residents individually to the restroom. By interviewing multiple sources, this LPA learned that carestaff have been seen by responsible parties implementing trips to the restroom every 2 hours. During this investigation, this LPA learned that the residents were kept bathed, shaven, dressed and offered the opportunity to participate in planned activities throughout the day. There was no evidence that incontinent care was being mismanaged or that residents in care were being double-briefed.

Regarding the third allegation: Staff restrain residents.
This LPA observed one resident who utilized a wheelchair that had a seatbelt. The LPA located a prescription dated 11/27/2021 which stated that is was "OK to use seat belt attached to the sit stand assist chair," signed by the resident's primary care physician.

Interviewees stated that their visits were unannounced and varied by day of the week, time of day, as well as in duration. 4 out of 4 responsible parties and 5 out of 5 carestaff stated that they had never witnessed issues concerning incontinence care, the use of restraints, or the implementation of restraining behaviors like making walkers or wheelchairs inaccessible to residents in care.

Based on the evidence collected during the course of this investigation, the 3 allegations have been determined to be UNFOUNDED. There was no evidence to indicate that there was a reasonable basis that the above allegations could have occurred.

No deficiencies were observed or cited during today's visit.

A copy of this report was provided.

Exit interview.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

LIC9099 (FAS) - (06/04)

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