345002854-4-19-2023-25-AS-LMUZ-CR4Q9J-20230421115824

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002854
Report Date: 04/19/2023
Date Signed: 04/19/2023 12:46:36 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
02/09/2023 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 25-AS-20230209115417

FACILITY NAME:	ALMOND GROVE ASSISTED LIVING		FACILITY NUMBER:	345002854
ADMINISTRATOR:	PRICE, DARRELL		FACILITY TYPE:	740
ADDRESS:	6135 ALMOND AVENUE		TELEPHONE:	(916) 988-7506
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	78	CENSUS: 55	DATE:	04/19/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Assistant Director, Tosha Devi		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility did not ensure COVID safety procedures were followed.

INVESTIGATION FINDINGS:

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On 04/19/2023, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to do complaint investigation for allegation listed above. LPA met with Assistant Director, Tosha Devi during today's inspection and explained the purpose of the visit. . LPA ensured hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask.

The department conducted records review ,facility observations and interviews to investigate the complaint.

**Report continued on LIC9099-C**

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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 25-AS-20230209115417

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: ALMOND GROVE ASSISTED LIVING	FACILITY NUMBER: 345002854
	VISIT DATE: 04/19/2023

NARRATIVE

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*** continued from LIC9099........

Allegation--Facility did not ensure COVID safety procedures were followed. -SUBSTANTIATED.

The Department conducted a records review, facility observation and interviews with staff members and residents to investigate this complaint allegation. During the course of the investigation, the Department learned R2 tested positive for COVID-19 in December 2022. R2 and R1 had a shared room at the time of R2’s positive test results. Per California Department Public Health (CDPH) and Community Care Licensing (CCL) guidelines long with local health department recommendations, when a resident tests positive for COVID-19, they are to isolate. The facility did not relocate either R1 or R2 when R2 tested positive. It has been concluded the facility did not follow infection control guidelines when R2 tested positive for COVID-19. Although R1 did not test positive for COVID-19, the residents should have been separated based on isolation protocol. The preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, a deficiency is being cited on the attached LIC9099-D page.

Exit interview conducted . Appeal Rights provided. Copy of this report has been given to facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 25-AS-20230209115417

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: ALMOND GROVE ASSISTED LIVING	FACILITY NUMBER: 345002854
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/19/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/03/2023 Section Cited CCR 87470(b)(3)	1 2 3 4 5 6 7	87470 Infection Control Requirements (b((3)-- (b) In addition to subsection (a), when one or more residents in the facility are diagnosed with a communicable disease, the following shall apply:(3) There shall be separation and care of residents whose illness requires separation, including quarantine or isolation, from others.This requirement is not met as evidence by,	1 2 3 4 5 6 7	Licensee/administrator will review regulation 87470 for Infection Control Requirements and complete a statement of understanding to Department. Facility will submit proof of submission and statement of understanding to Department by POC due date by 05/03/23.
	8 9 10 11 12 13 14	Facility did not separate R1 from R2 when R2 tested positive for covid-19 in December 2022 as required by above stated section which poses a potential health risks to residents in care for their health and safety.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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 NORTH ASC, 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
02/09/2023 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 25-AS-20230209115417

FACILITY NAME:	ALMOND GROVE ASSISTED LIVING		FACILITY NUMBER:	345002854
ADMINISTRATOR:	PRICE, DARRELL		FACILITY TYPE:	740
ADDRESS:	6135 ALMOND AVENUE		TELEPHONE:	(916) 988-7506
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	78	CENSUS: 55	DATE:	04/19/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Assistant Director, Tosha Devi		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not ensure accurate information was provided to residents responsible party .

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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 25-AS-20230209115417

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: ALMOND GROVE ASSISTED LIVING	FACILITY NUMBER: 345002854
	VISIT DATE: 04/19/2023

NARRATIVE

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*** continued from LIC9099........

Allegation- Staff did not ensure accurate information was provided to resident’s responsible party. -UNSUBSTANIATED

Department did record review, facility observation and interviews with staff members and residents to investigate this complaint allegation. Department reviewed emails and written correspondence from facility to residents and their responsible parties in December 2022 regarding sharing information for COVID-19 positive cases at the facility. Based on documentation, the facility did not identify any specific resident in its communication regarding facility COVID-19 cases. The Department cross-checked COVID-19 positive cases information from other departments and did not find any discrepancies. Based on residents and staff interviews, it has been concluded that facility provided accurate COVID-19 information to residents and families in a timely manner and did not alter or falsify any COVID-19 information regarding R1’s health condition. Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC9099 (FAS) - (06/04)

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