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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701251
Report Date: 10/24/2024
Date Signed: 11/04/2024 03:44:31 PM

Substantiated


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
07/09/2024 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240709170841
FACILITY NAME:APPLE RIDGE ASSISTED LIVING, LLCFACILITY NUMBER:
342701251
ADMINISTRATOR:KHODORKOVSKY, AARONFACILITY TYPE:
740
ADDRESS:3950 ANNADALE LANETELEPHONE:
(916) 489-6900
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:94CENSUS: 83DATE:
10/24/2024
UNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Alfredo Cruz TIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility staff did not assist residents with hygiene needs
INVESTIGATION FINDINGS:
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On 10/24/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Alfredo Cruz and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegation above.
Current census was 83. A brief interview with FDA Cruz was conducted.
Allegation: Facility staff did not assist residents with hygiene needs
It was alleged that facility staff did not assist residents with hygiene needs. During the course of this investigation, this LPA reviewed facility documentation and conducted staff and resident interviews. In interviews with 9 staff members, 5 out 9 expressed confidence in their ability to assist residents with hygiene but reported witnessing some colleagues neglecting these needs during certain shifts. They noted that upon starting their shifts, they often found residents soiled in urine, with messes extending from incontinence pads onto bedding. Additionally, 5 out of 9 staff members mentioned that residents have complained about not receiving showers for several weeks. Meanwhile, 4 out 9 staff members denied any inability to assist residents with hygiene.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
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 5
Control Number 27-AS-20240709170841
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: APPLE RIDGE ASSISTED LIVING, LLC
FACILITY NUMBER: 342701251
VISIT DATE: 10/24/2024
NARRATIVE
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Interviews with 9 residents revealed that all needed assistance with incontinence care and showering. 7 out 9 residents reported being left in soiled incontinence briefs for 3 to 7 hours, stating that staff are aware of their condition but often do not provide timely assistance. Furthermore, 7 out 9 residents indicated they do not receive regular showers, with some receiving only two showers a month.

The LPA reviewed the facility's AM and PM shower schedule, which indicated that residents are scheduled for full showers two to three times a week. Additionally, a review of 9 resident files confirmed that the facility provides support with hygiene needs, including toileting, incontinence care, grooming, and showering.

LPA Pascua conducted three unannounced visits on July 16, 2024; September 19, 2024; and October 18, 2024. During these visits, a strong odor of urine was consistently noted in hallways 2 and 3.

Based on interviews and record review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met.

The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

An exit interview was conducted, appeals rights, and a copy of this report was provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20240709170841
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: APPLE RIDGE ASSISTED LIVING, LLC
FACILITY NUMBER: 342701251
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
11/25/2024
Section Cited
CCR
87464(f)(4)
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(4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports.
This is not met as evidenced by:
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Administrator states statement of correction shall be submitted, along with staff training no less than an 1 hr in duration for the section cited. Copies of correction and staff training shall be submitted to the LPA by the POC date.
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Based on observation, record review, and interviews the facility did not provide personal assistance and care with activities of daily living such as incontinence care, bathing and toileting. It was learned that 5 staff members have witnessed facility staff not providing hygiene needs and 7 residents stated that they do not receive consistent hygiene care. Through record review, it was learned that all residents are scheduled and should obtain consistent hygiene care. In addition, LPA observed a strong urine smell in hallways 2 and 3 during a course of 3 unannounced visits. This poses a potential health, safety, and personals rights risks to persons in care.
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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.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
07/09/2024 and conducted by Evaluator Arielle Pascua
COMPLAINT CONTROL NUMBER: 27-AS-20240709170841

FACILITY NAME:APPLE RIDGE ASSISTED LIVING, LLCFACILITY NUMBER:
342701251
ADMINISTRATOR:KHODORKOVSKY, AARONFACILITY TYPE:
740
ADDRESS:3950 ANNADALE LANETELEPHONE:
(916) 489-6900
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:94CENSUS: DATE:
10/24/2024
UNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Alfredo Cruz TIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff stole from residents
Facility air conditioning is in disrepair
INVESTIGATION FINDINGS:
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On 10/24/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Alfredo Cruz and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.
Current census was 83. A brief interview with FDA Cruz was conducted.

Allegation: Facility Staff stole from residents
It was alleged that facility staff stole from residents. During the course of this investigation, this LPA reviewed facility documentation and conducted staff and resident interviews. All 9 staff members interviewed denied stealing from residents and reported never witnessing any theft by colleagues. Additionally, none of the staff had heard of any incidents involving theft.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20240709170841
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: APPLE RIDGE ASSISTED LIVING, LLC
FACILITY NUMBER: 342701251
VISIT DATE: 10/24/2024
NARRATIVE
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Interviews with 9 residents revealed that 7 reported no missing personal items. However, 2 residents indicated that they had noticed items missing from their rooms but were uncertain whether they had misplaced them or if someone else had taken them. A review of facility documentation indicated recent reports of missing monetary items, headphones, and other miscellaneous belongings. However, the facility could not determine whether these items were misplaced or stolen by staff. Based on the information gathered, it is unclear if the facility staff stole from residents

Allegation: Facility air conditioning is in disrepair

It was alleged that the facility air conditioning is in disrepair. During the course of this investigation, this LPA reviewed facility documentation and conducted staff and resident interviews. Interviews revealed that on May 31, 2024, the air conditioning unit in Hallway 3 was functioning intermittently. By June 3, the staff discovered that the AC system had completely failed. On the same day, the facility contacted multiple vendors to assess the situation and confirmed the complete failure of the AC unit. A down payment of $10,000 was made for a new system, and the facility purchased nine portable AC units from Home Depot to install in the bedrooms of Hallway 3. Temperature checks were conducted to ensure compliance with regulatory standards.

On June 24, 2024, the new AC unit was delivered and installed by the vendor, with confirmation that it was operational. The final invoice for the AC unit was paid on July 8, 2024. Interviews with nine residents confirmed that the air conditioning had been fixed and that portable units were provided while the main system was down. 3 of the 9 residents noted some discomfort but found it manageable with the portable units, while 6 out of 9 residents reported no issues at all.

A review of invoices from Wallace Heating and Air and Home Depot confirmed the purchase and installation dates of the new AC unit. The facility's Temperature Log showed that from July 2024 to the present, the temperatures in resident bedrooms remained between 71-75 degrees. Additionally, temperature readings taken in 10 resident bedrooms indicated temperatures between 70-74 degrees.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5