342701097-12-31-2024-27-AS-KHOS-DD6JXP-20250122062641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701097
Report Date: 12/31/2024
Date Signed: 12/31/2024 02:11:01 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
12/09/2024 and conducted by Evaluator Arvin Villanueva

COMPLAINT CONTROL NUMBER: 27-AS-20241209094904

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:	12/31/2024
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Susan McClure, Assistant Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility installed a surveillance device in a resident's room without consent.

INVESTIGATION FINDINGS:

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On 12/31/2024, at 2pm, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility to conduct a follow up complaint visit regarding the allegation noted above. LPA met with Susan McClure and stated the purpose of this visit.

The investigation included interviews with relevant parties, observation of the facility, including resident rooms and common areas, and a review of pertinent records, such as resident admission agreement and care notes.
Interview with an outside agency reported inspecting R1’s room and found no evidence of surveillance devices. Interview with facility staff revelaed that surveillance cameras were installed only in common areas for monitoring purposes and that no cameras were placed in resident rooms. From the interviews with residents, one resident suspected that the smoke detector in their room contain a hidden camera. R1 informed LPA that they were becoming suspicious after returning from a trip and pointed to the device installed at the ceiling, which had been partially wrapped in paper, as evidence of hidden camera.
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Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024

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-20241209094904

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: SKYPARK MANOR	FACILITY NUMBER: 342701097
	VISIT DATE: 12/31/2024

NARRATIVE

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LPA and facility staff conducted facility observation which include inspections of 11 resident units. Of all the resident units were inspected, LPA did not find any clear evidence of surveillance devices, including cameras. Devices that were observed installed at the ceilings of resident units were identified as smoke detectors and sprinkler systems. However, the only visible surveillance cameras that were observed were in common areas, including hallways and dining rooms, but not in private units or bathrooms.

Record review of Admission Agreement explicitly states that no surveillance devices are installed in private rooms. The agreement also specifies that residents would be notified prior to the implementation of such devices in private areas.

Based on interviews, facility observations, and document reviews, the allegation that Skypark Manor staff installed a surveillance device in resident's room without consent is UNFOUNDED. The devices in question were identified as standard safety equipment, and no evidence was found to support the claim. Note that a finding that is unfounded means that the allegation is false, could not have happened, or is without a reasonable basis.

No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024

LIC9099 (FAS) - (06/04)

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