342701097-9-29-2023-27-AS-KHOS-CW8KBF-20231002074524

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701097
Report Date: 08/18/2023
Date Signed: 09/29/2023 03:47:11 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
08/02/2023 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230802083802

FACILITY NAME:	SKYPARK MANOR		FACILITY NUMBER:	342701097
ADMINISTRATOR:	RICHARDSON, SHERRY		FACILITY TYPE:	740
ADDRESS:	5510 SKY PARKWAY		TELEPHONE:	(916) 422-5650
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	144	CENSUS: 85	DATE:	08/18/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Rabindar Singh		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff neglected resident while in care
Staff failed to meet resident's needs

INVESTIGATION FINDINGS:

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On 08/18/2023 at 2:45 PM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at this facility to conduct a complaint visit. LPA met with Business Office Manager, Rabindar Signhand explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above. Throughout the course of this investigation, the Department conducted interviews, reviewed facility files, and reviewed medical documents.

Allegation: Staff neglected resident while in care
It was alleged that the facility neglected resident in care. LPA Lee interviewed 10 out of 10 residents. It was learned that 8 out of 10 residents had no concerns regarding facility staff neglecting residents while in care. LPA Lee interviewed 10 out of 10 staff and 10 out of 10 facility staff denies that residents are neglected while in care.

Continued LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

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 4

Control Number 27-AS-20230802083802

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SKYPARK MANOR	FACILITY NUMBER: 342701097
	VISIT DATE: 08/18/2023

NARRATIVE

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Allegation: Staff failed to meet resident’s needs
It was alleged that the staff failed to meet resident’s needs. LPA Lee interviewed 10 out of 10 residents. It was learned that 8 out of 10 residents had no concerns regarding staff failed to meet resident’s needs. LPA Lee interviewed 10 out of 10 staff and 10 out of 10 facility staff denies that staff are not meeting resident’s needs.

There was no evidence found to support the allegations. As a result of this investigation, and based on LPA’s observations, and interviews the allegation(s) are deemed to be UNSUBSTANTIATED - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, the preponderance of evidence standards has not been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies are being cited. An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
08/02/2023 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230802083802

FACILITY NAME:	SKYPARK MANOR		FACILITY NUMBER:	342701097
ADMINISTRATOR:	RICHARDSON, SHERRY		FACILITY TYPE:	740
ADDRESS:	5510 SKY PARKWAY		TELEPHONE:	(916) 422-5650
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	144	CENSUS: 85	DATE:	08/18/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Rabindar Singh		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
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9

Staff member withholds food from resident

INVESTIGATION FINDINGS:

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7
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13

On 08/18/2023 at 2:45 PM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at this facility to conduct a complaint visit. LPA met with Business Office Manager, Rabindar Signh and explained the purpose of the visit. The purpose of this visit was to deliver complaint finding for the allegation above. Throughout the course of this investigation, the Department conducted interviews, reviewed facility files, and reviewed medical documents.

Allegation: Staff member withholds food from resident
It was alleged that the facility staff withhold food from resident. LPA Lee interviewed 10 out of 10 residents. It was learned that 10 out of 10 residents had no concerns regarding staff member withholding food from residents. 9 out of 10 residents stated that they enjoy the food being served in the facility. LPA Lee interviewed 10 out of 10 staff and 10 out of 10 facility staff denies that staff members are withholding food from resident. It was learned that there are snacks,sandwhiches, milk and jucie in the font office refrigerator for residents to grab.
Continued LIC 9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

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 4

Control Number 27-AS-20230802083802

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SKYPARK MANOR	FACILITY NUMBER: 342701097
	VISIT DATE: 08/18/2023

NARRATIVE

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During R1's interview R1 denied any staff by the name (S1) took R1's food. It was also learned that there is no staff employed by the name Dan. On 08/04/2023, LPA Lee observed both breakfast and lunch time and it was learned that residents comes to the dining area to have meals. It was also learned that if residents doesn't come to the dining table for meal time, then meals are brought to the residents room. LPA Lee observed kitchen staff prepping lunch and meals were placed on a chart to bring to residents who are in their room and chose not to come to the dinning table for breakfast and lunch.

There was no evidence found to support the allegation of staff member withhold food from resident. The allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened, or is without a reasonable basis. An exit interview was conducted, and a copy of this report was given to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4