342701097-2-6-2025-27-AS-SRIN-DEBS5E-20250228123412

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701097
Report Date: 02/06/2025
Date Signed: 02/06/2025 03:51:37 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
10/17/2024 and conducted by Evaluator Arvin Villanueva

COMPLAINT CONTROL NUMBER: 27-AS-20241017115504

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:	DATE:	02/06/2025
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Susan McClure		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Staff are not preventing resident from harassing other residents in care.

INVESTIGATION FINDINGS:

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On 2/6/2025, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced at this facility to conduct a follow up complaint visit regarding the allegation noted above. LPA met with Susan McClure, Assistant Administrator, and stated the purpose of this visit.

The investigation into the above allegation consisted of interviews and record reviews.

A review of Resident1’s (R1) documents indicated several instances of agitation and confusion, consistent with their diagnosis (D1) dementia and Alzheimer’s. These behaviors included occasional aggressive actions, such as trying to hit other residents, shouting, and entering other residents' rooms mistakenly. However, there was no consistent evidence that R1 intentionally harassed other residents or that the staff failed to intervene appropriately.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025

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-20241017115504

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: 02/06/2025

NARRATIVE

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Interviews with care staff (S1 – S6), including those who have worked closely with R1, consistently described R1 as a kind person who does not have malicious intent towards others. Staff members reported that R1’s actions were largely a result of their cognitive impairments and confusion, which led R1 to occasionally enter other residents' rooms by mistake or engage in disruptive behaviors, like shouting. R1’s inability to remember basic facts and their tendency to wander were contributing factors to their confusion. Additionally, interviews did not indicate that R1 had physically harmed or verbally abused other residents with intent.

Interviews also revealed that R1 had a history of confusion with room locations, particularly with a Resident2 (R2), who had previously complained about R1 entering their room. However, R2 had relocated to another part of the facility, and since that move, there had been no further complaints. Also staff had stated that they actively worked to manage R1’s behaviors by providing constant supervision and assistance with activities of daily living (ADLs), including showering, meals, and ensuring R1’s safety while wandering the facility.

Although R1’s behaviors were occasionally disruptive, there was no evidence that staff ignored or failed to address these issues. Staff were aware of R1’s condition and took measures to offer R2 another location to move to within the facility. Based on the information gathered, the allegation that staff are not preventing R1 from harassing other residents in care was found to be UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened the preponderance of evidence does not prove it.

Exit interview was conducted with Susan McClure and a copy of this report and appeal rights were provided.

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SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025

LIC9099 (FAS) - (06/04)

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