342701248-8-12-2024-27-AS-KHOS-D84JLV-20240813070922

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701248
Report Date: 08/12/2024
Date Signed: 08/12/2024 09:50:24 AM

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
05/21/2024 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240521154127

FACILITY NAME:	SACRAMENTO SENIOR LIVING II		FACILITY NUMBER:	342701248
ADMINISTRATOR:	LEWIS, SALOTE		FACILITY TYPE:	740
ADDRESS:	34 LOMA MAR CT		TELEPHONE:	(530) 710-5707
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY:	6	CENSUS: 5	DATE:	08/12/2024
		UNANNOUNCED	TIME BEGAN:	08:46 AM
MET WITH:	Melvin Hinds		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility is not meeting the hygiene needs of a resident in care.
Staff did not ensure that resident was wearing shoes when being transported to the hospital.

INVESTIGATION FINDINGS:

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On 08/12/2024 at 8:46 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with care giver Melvin Hinds and explained the purpose of the visit. LPA Lee explained the purpose of this visit is to deliver complaint findings for the allegations above. Care giver called administrator Salote Lewis and was not able to get a hold of the administrator. The current census is 5 with 1 facility staff. A brief interview with conducted with care giver Melvin.

Allegation: Facility is not meeting the hygiene needs of a resident in care.
It was alleged that the facility is not meeting the hygiene needs of a resident in care. This investigation consisted of observations, records reviewed, interviews with staff and residents. Throughout the course of the investigation, LPA Lee observe 5 out of 5 residents on 05/30/2024 and all the residents appeared to be in good hygiene. 5 out of 5 residents did not observe to have any outgrown fingernails. All residents were observed to be clean and comfortable. During today's visit, LPA Lee also observed 3 resident who was present in the home to appear clean and groomed.
Continued LIC 9099-

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024

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-20240521154127

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: SACRAMENTO SENIOR LIVING II	FACILITY NUMBER: 342701248
	VISIT DATE: 08/12/2024

NARRATIVE

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LPA Lee interviewed 5 out of 5 residents who stated that they have no concern with facility staff not meeting the resident’s hygiene needs. LPA Lee interviewed resident 1 (R1) using (R1)’s iPad. (R1) stated that (R1) has no concerns with facility not meeting (R1)’s hygiene needs. Based on interview with (R1)’s responsible party (RP), (RP) has no concerns and stated that facility staff are encouraging and reminding (R1) to take showers and that sometimes (R1) refuses services from the staff.

Based on (R1)’s record review it was learned that (R1)’s personal grooming consisted of brushing teeth, facial wash, brush/style hair, shave facial hair, dressed appropriately, apply lotion/deodorant, nail care and maintenance and shower/sponge bath. (R1) is receiving (R1)’s personal grooming from the facility staff. Records review also indicated that (R1) is receiving 4 sponge bath and 3 showers from 04/15/2024 to 06/02/2024. LPA was unable to corroborate the allegation that facility staff is not meeting hygiene needs of residents in care. All resident interviewed denied the allegations.
The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation is found to be UNSUBSTANTIATED.

Allegation: Staff did not ensure that resident was wearing shoes when being transported to the hospital.

It was alleged that staff did not ensure that resident was wearing shoes when being transported to the hospital. This investigation consisted of observations and interviews with staff and residents. Throughout the course of the investigation, LPA Lee observe 5 out of 5 residents on 05/30/2024 who either had on shoes, socks and slipper. It was observed that (R1) was wearing socks and had on a slipper. LPA Lee also interviewed 5 out of 5 residents who did not witness (R1) being transported to the hospital without shoes. LPA Lee also interviewed (R1) who communicated with LPA Lee via iPad. LPA Lee asked resident to explain what happen when (R1) was transported to the hospital and if (R1) had any shoes and socks on and (R1) stated “good.” (R1) stated (R1) has no concerns. Based on interview with (R1)’s responsible party (RP), (RP) has no concerns and stated that (RP) visits (R1) occasionally and does observe (R1) to have socks and slippers on. It was learned from administrator that on 05/20/2024 the facility staff called EMT for (R1) since (R1) have been refusing (R1)’s medication from 05/17/2024 to 05/19/2024. It was also learned that (R1) was being combative with the EMT staff and the facility staff. (R1) was being combative because (R1) didn’t want to go to the hospital. Administrator stated that (R1) may have lost (R1)’s shoe during the altercation and is not sure since administrator was not present that day.

Continued LIC 9099-C

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20240521154127

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: SACRAMENTO SENIOR LIVING II	FACILITY NUMBER: 342701248
	VISIT DATE: 08/12/2024

NARRATIVE

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It is unclear if resident was transported to the hospital with or without shoe. Regarding the allegation that staff did not ensure that resident was wearing shoes when being transported to the hospital, there is not a preponderance of evidence to prove that it occurred. LPA was unable to corroborate the allegation that staff did not ensure that resident was wearing shoes when being transported to the hospital. All resident interviewed denied any knowledge of the allegation and the described incident while (R1) was being transported to the hospital.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that the complaint allegation is UNSUBSTANTIATED means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.

An exit interview was conducted with the facility staff and a copy of this report was left at the facility with care giver Melvin Hindes at the end of today’s visit.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024

LIC9099 (FAS) - (06/04)

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