342701155-12-28-2023-27-AS-KHOS-CZ6S2M-20240104122945

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701155
Report Date: 12/28/2023
Date Signed: 12/28/2023 12:42:02 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
11/20/2023 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20231120231057

FACILITY NAME:	MILESTONE CAREHOME INC		FACILITY NUMBER:	342701155
ADMINISTRATOR:	MERCADO, JENNIFER		FACILITY TYPE:	735
ADDRESS:	9001 GENERATIONS DR		TELEPHONE:	(916) 478-0478
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	4	CENSUS: 3	DATE:	12/28/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Jennifer Mercado		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff spoke to resident in an inappropriate manner.
Staff did not allow resident in common areas of facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Jennifer Mercado and explained the purpose of the visit.

This investigation consisted of interviews, observation, and record review. LPA Moleski interviewed Mercado, four staff members (S1-S4), one former resident (R1), a former residents responsible parties (R1’s RPs), one resident (R2), and two service coordinators at Alta California Regional Center (ACRC). LPA Moleski reviewed resident records and facility records.

LPA Moleski visited the facility on 11/30/23 and 12/12/23. LPA Moleski observed residents in the common areas of the facility on each of these visits.

[continued on 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

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-20231120231057

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: MILESTONE CAREHOME INC	FACILITY NUMBER: 342701155
	VISIT DATE: 12/28/2023

NARRATIVE

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During interviews, Mercado and S1-S4 said R1 occasionally spent time in common areas, but that R1 preferred spending time in R1’s room. Mercado and S1-S4 said R1 was not prohibited from spending time in common areas of the facility. Mercado and S1-S4 said staff encouraged R1 to spend time in the common areas, but that R1 was not usually receptive to the encouragement. S1-S4 could not identify any staff members who did not get along with R1. S1-S4 said no staff members spoke disrespectfully to R1.

LPA Moleski was able to interview one resident living at the facility (R2). R2 said R1 sometimes spent time with the other residents in the living room, but R1 usually stayed in R1’s bedroom. R2 said staff were not mean to R1, and said that staff did not call R1 any disrespectful names.

During an interview, LPA Moleski asked R1 about R1’s time at this facility. R1 said a male staff member used a profane word to address R1 and made an obscene gesture at R1. R1 said R1 took meals in R1’s room, and did not enjoy this arrangement. During this same conversation, R1 also described events which allegedly occurred while previously living at different facilities.

LPA Moleski reviewed daily notes in R1’s file dated between 5/26/23 and 11/18/23. Throughout this time period, R1 occasionally spent time in common areas of the facility, but predominantly spent time in R1’s room, according to the notes. On several occasions, staff encouraged R1 to engage with the other residents, but R1 often declined, according to the notes.

LPA Moleski reviewed photographs of R1 taken in the facility and on outings. A series of photographs show R1 helping to decorate the facility for the holidays. Another series of photographs show R1 eating a meal in the living room alongside other residents.

The department has determined the following as it relates to the allegations that staff spoke to a resident in an inappropriate manner, and that staff did not allow a resident in common areas of the facility:

Based on interviews, observation, and record review, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Mercado.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

LIC9099 (FAS) - (06/04)

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