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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701251
Report Date: 10/24/2024
Date Signed: 10/24/2024 01:08:38 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
07/31/2024 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240731123011
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:
11:00 AM
MET WITH:Alfredo Cruz TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility staff did not meet resident's incontinence care needs
Facility staff did not answer resident's call button
Facility staff yelled at resident(s)
Facility staff spoke inappropriately to resident(s)
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 meet resident's incontinence care needs
It was alleged that facility staff did not meet resident’s incontinence care needs. During this investigation, the LPA reviewed facility documentation and conducted interviews with both staff and residents.
Interviews with nine staff members revealed that 5 out of 9 believe they can adequately address residents' incontinence care needs, yet they have observed that some colleagues on certain shifts fail to provide this care. These staff members reported instances where they found residents soiled in urine, with messes extending from incontinence pads onto bedding at the start of their shifts. 4 out 9 staff members denied any inability to assist with incontinence care.
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 6
Control Number 27-AS-20240731123011
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 indicated that all require assistance with incontinence care and showering. 7 out 9 residents reported being left in soiled incontinence briefs for approximately 3 to 7 hours, stating that staff are aware of their condition but do not provide the necessary assistance.

In addition, LPA Pascua conducted 3 unannounced visits on 07/16/2024 at 1:30pm to 5:00pm, 09/19/2024 at 10:00am-5:00pm, and 10/18/2024 at 6:30am-11:00am. During these visits, LPA Pascua observed a strong urine smell in consistently detected 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.



This deficiency is addressed on the complaint investigation dated 10/24/2024 and a plan of correction has been established. Therefore, there will not be a LIC9099-D page for this substantiated finding.

Allegation: Facility staff did not answer resident's call button

It was alleged that facility staff did not answer resident’s call button. During the course of this investigation, this LPA reviewed facility documentation and conducted staff and resident interviews. 9 staff members were interviewed, 5 out of 9 acknowledged that they do not always answer call buttons immediately and that it may take some time to respond due to assisting other residents. They indicated that staff are expected to respond within 15 to 30 minutes, although they admitted that actual response times are often longer. In contrast, 4 out of 9 staff members denied any issues with responding to call buttons.

Interviews with 9 residents revealed that 8 had used their call buttons but had stopped doing so due to delays in response. Many reported being left unanswered for extended periods, sometimes for hours or even overnight. A review of the facility’s call button log from May to August 2024 showed average response times of 3 to 6 hours in May and June, and 2 to 3 hours in July and August. Based on the information gathered, the facility staff did not answer the resident’s call button.

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.

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 6
Control Number 27-AS-20240731123011
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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Allegation: Facility staff spoke inappropriately to resident(s)

It was alleged that the facility staff spoke inappropriately to residents. During the course of this investigation, this LPA conducted staff and resident interviews. Based on interviews with 9 staff members, 5 out of 9 reported having heard colleagues speak inappropriately to residents. They noted that while many of these staff members have been fired or no longer work at the facility, some continue to engage in such behavior. 4 out 9 staff members denied ever hearing or participating in inappropriate communication.

Interviews with 9 residents revealed that 8 out 9 have heard staff speak inappropriately, with 7 out 9 stating they have personally experienced inappropriate comments from staff, such as “This is why you are in a facility because you cannot help yourself”. Only 1 resident reported not having heard any inappropriate remarks directed at them or others.

Residents also mentioned that many staff members who previously spoke inappropriately are no longer employed at the facility. However, it was noted that some staff occasionally make inappropriate comments in front of residents, even if not directed at them. Additionally, residents frequently hear inappropriate language in the hallways. Based on the information gathered, facility staff spoke inappropriately to residents. Based on the information gathered, facility staff spoke inappropriately to residents.

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.

Allegation: Facility staff yelled at resident(s)

It was reported that staff at the facility yelled at residents. During this investigation, the LPA conducted interviews with both staff and residents. Out of 9 staff interviews, 5 staff members indicated they had heard colleagues yelling at residents. They noted that most of those who yelled have since been fired or no longer work at the facility, although some staff still engage in this behavior. Conversely, 4 staff members denied having heard or participated in any yelling with residents.

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: 3 of 6
Control Number 27-AS-20240731123011
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 8 of them had heard staff yelling. Only one resident reported no instances of staff yelling at them. Residents also mentioned that many of the staff who yelled no longer work there but acknowledged that staff sometimes yell in front of them, even if not directed at them. Additionally, it was noted that residents frequently hear staff yelling in the hallways.

A review of facility town hall notes indicated that this issue has been addressed, with staff being encouraged to use walkie-talkies or phones for communication. Based on the gathered information, facility staff have yelled at residents.

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.

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: 4 of 6
Control Number 27-AS-20240731123011
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)
Type A
10/25/2024
Section Cited
CCR
87411(a)
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(a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.
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Administrator stated that a statement of acknowledgement and correction shall be sumbitted to the LPA by the POC date 10/25/2024.
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This is not met as evidenced by: Based on record review and interview, the licensee did not ensure that there are sufficient staff to ensure that call buttons are met within a sufficient period. It was learned that the facilities best practice is to answer call buttons within a 15-30 min period, however based on interviews conducted with staff and residents’ response time can vary past 2 hours or even overnight due to assistance with other residents. LPA reviewed facility call button logs which confirm this response time. This poses an immediate health, safety and personal rights risks to persons in care.
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Deficiency Dismissed
Type A
10/25/2024
Section Cited
CCR
87468.1(a)(3)
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(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.
This is not met as evidenced by:
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Administrator stated that a statement of acknowledgement and correction shall be submitted to the LPA by the POC date 10/25/2024. Copies of training will be submitted to LPA by 11/25/2024.
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Based on interviews, the Licensee did not ensure that facility staff did not ensure that facility staff did not speak inappropriately to residents in care. It was learned that staff would often speak to residents while providing assistance and make commentary that would be inappropriate to say to the resident and around others. This poses an immediate health, safety, and personal 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: 5 of 6
Control Number 27-AS-20240731123011
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 A
10/25/2024
Section Cited
CCR
87468.1(a)(1)
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(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
This is not met as evidenced by:
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Administrator stated that a statement of acknowledgement and correction shall be submitted to the LPA by the POC date 10/25/2024. Copies of training will be submitted to LPA by 11/25/2024.
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Based on interviews and record review, the Licensee did not ensure that the facility staff did not yell at the residents. It was learned that often times, residents would hear staff members yelling at other residents or staff while caring for others. This poses an immediate health, safety, and personal 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: 6 of 6