345002854-3-27-2024-59-AS-KHOS-D3XLVV-20240402090609

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002854
Report Date: 03/27/2024
Date Signed: 03/27/2024 12:34:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
02/13/2024 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20240213104120

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: 60	DATE:	03/27/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Assistant Director, Tosha Devi		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff are not following physician's instructions.
Staff did not ensure resident's oxygen tank is accessible to resident.
Staff did not provide a beverage to resident as requested.
Staff did not ensure resident was given a meal.

INVESTIGATION FINDINGS:

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On 03/27/24, Licensing Program Analysts (LPAs) Talwinder Bains and Cheyenne Ratajczak arrived unannounced to deliver complaint findings for allegations listed above. LPAs met with Assistant Director, Tosha Devi during today's visit and explained the purpose of the visit. .

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

**Report continued on LIC9099-C**

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: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

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 59-AS-20240213104120

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ALMOND GROVE ASSISTED LIVING	FACILITY NUMBER: 345002854
	VISIT DATE: 03/27/2024

NARRATIVE

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***Report continued from 9099.......
Allegation- Staff are not following physician's instructions.

Based on the information provided, the investigation conducted by the department involved facility observations, record review, and interviews with staff and residents to investigate the complaint allegation. During these interviews, it was revealed that the facility follows physicians’ orders to take care of residents’ needs and document accordingly. 3 out of 4 Resident’s interviews indicated that staff were assisting them with their medications and other care needs without any issues. Furthermore, a review of the records for the months of January and February 2024, indicated that the facility maintained a proper logs for all medications administration and other care notes for residents per their physician’s orders without any errors. Based on these findings, this allegation is considered UNSUBSTANTIATED.

Allegation- Staff did not ensure resident's oxygen tank is accessible to resident.

Based on the information provided, the investigation conducted by the department involved facility observations, record review, and interviews with staff and residents to investigate the complaint allegation. During department visits, it has been observed that residents have access to their oxygen tanks and other assistive equipment per their physician’s orders and staff were assisting residents without any issues. 3 out of 4 resident’s interviews indicated that staff were assisting them with their care needs on daily basis and there were no problems. Based on this information, this allegation is found to be UNSUBSTANTIATED.

Allegation- Staff did not provide a beverage to resident as requested. Staff did not ensure resident was given a meal.

An investigation has been conducted regarding the above allegation. LPA observed the facility’s food supply as well as interviewed residents regarding the food service. Based on observation and interviews, the facility keeps the required amount of food supply in the facility. Additionally, 3 out of 4 residents interviews indicated that residents are satisfied with the food service at the facility and feel that they have enough food to eat at every meal. During resident’s interviews, it has been found out that residents can request their meal tray in their rooms if they do not want to eat in dining room. 3 out of 4 residents stated that there were no issues with tray delivery service to their rooms and they did not miss any meals. 4 out of 4 staff interviewed indicated that they were not aware of any issues with residents missing their meals. Based on the information, this allegation is found to be UNSUBSTANTIATED.

A copy of this report has been provided to facility. Exit interview conducted.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

LIC9099 (FAS) - (06/04)

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