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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701161
Report Date: 11/23/2022
Date Signed: 11/28/2022 12:40:49 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/14/2022 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20221114143503
FACILITY NAME:MARCONI VILLAFACILITY NUMBER:
342701161
ADMINISTRATOR:DHANOA, MANPREETFACILITY TYPE:
740
ADDRESS:2100 MARCONI AVENUETELEPHONE:
(916) 571-5270
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:6CENSUS: 4DATE:
11/23/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Manpreet DhanoaTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Staff were not meeting residents hygiene needs.
Staff did not change the residents sheets timely.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced on 11/28/2022 at 8:30 AM to follow up on a complaint investigation and deliver findings, LPA Martinez met with Manpreet Dhanoa explained the purpose of the visit.

Throughout the course of the investigation, LPA Martinez conducted interviews, toured the facility, and reviewed documents. LPA Martinez reviewed resident 1 (R1) daily charting records. LPA Martinez was informed R1 is scheduled to have three baths per week. LPA Martinez reviewed R1's shower log for October 2022, and the log reported R1 had a total of five baths in October 2022. LPA Martinez was also informed resident 2 (R2) did not receive baths. As a result, it was determined the facility was not meeting residents' hygeine needs.

Continued...

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022
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 3
Control Number 27-AS-20221114143503
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: MARCONI VILLA
FACILITY NUMBER: 342701161
VISIT DATE: 11/23/2022
NARRATIVE
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Moreover, LPA Martinez toured the facility on November 17, 2022 and November 28, 2022. During these visit, LPA Martinez observed that residents' rooms were not cleaned. LPA Martinez observed dead pest on window sils, unsanitary floors, and bed sheets missing, and pillows did not have pillow casing. Based investigation it was determined facility sheets are being changed timely.

As a result of this investigation, the Department finds these allegations to be Substantiated. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations.

An exit interview was conducted, and a copy of the 9099 report, LIC 9099-D, and appeal rights were given to the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20221114143503
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: MARCONI VILLA
FACILITY NUMBER: 342701161
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2022
Section Cited
CCR
87464(f)(1)
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Basic Services 87464(f)(1): Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidence by:
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Licensee agrees to conduct staff training on basic services by plan of correction (POC) date 12/19/2022. Licensee agrees to email training documents to LPA Martinez on POC date 12/19/2022.
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Based on observation, interviews, and file review, the licensee did not ensure R1 was received baths. This posed a potential health and safety risk to R1
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Type B
12/19/2022
Section Cited
CCR
87468.1(a)(2)
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Personal Rights of Residents in All Facilities 87468.1(a)(2):esidents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidence by:
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Licensee agrees to conduct staff training on personal rights by plan of correction (POC) date 12/19/2022. Licensee agrees to email training documents to LPA Martinez on POC date 12/19/2022.
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Based on observation, interviews, and file review, the licensee did not ensure facility sheet were changed and clean. This posed a potential health and safety risk to R1
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3