345002857-4-20-2023-59-AS-MSEY-CR4RHK-20230421130229

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002857
Report Date: 04/20/2023
Date Signed: 04/20/2023 05:08:35 PM

Unfounded

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
03/28/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230328174657

FACILITY NAME:	ROBERT CREEK VILLA		FACILITY NUMBER:	345002857
ADMINISTRATOR:	KING, MARICAR		FACILITY TYPE:	740
ADDRESS:	8134 ROBERT CREEK COURT		TELEPHONE:	(925) 597-8181
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 5	DATE:	04/20/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Maricar King, Administrator		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Residents are chemically restrained with medication
Facility staff not fingerprint-cleared
Staff are using drugs while on duty
Facility staff are abusing residents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sabrina Calzada arrived at the facility unannounced to conclude the complaint investigation for above allegations. LPA met with Administrator Maricar and explained the purpose of the visit.

During today's investigation, LPA interviewed Administrator, (2) staff and (3) residents and confirmed photo ID's for (3) staff present. Medications were reviewed for (5) residents on 4/4/23. Facility uses the Medication Administration Record (MAR) to record medications that are administered daily. Copies of MAR's were provided to the Department on 4/4/23 and staffing schedules were provided, as requested, on 4/11/23.

The results of the investigation are as follows:

cont on 9099C(1)..

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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 3

Control Number 59-AS-20230328174657

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: ROBERT CREEK VILLA	FACILITY NUMBER: 345002857
	VISIT DATE: 04/20/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

9099C(1)... Allegation: Residents are chemically restrained with medication. Complaint alleges that staff are giving residents medication to keep them sleeping.
Interviews with staff indicated that residents are only given medications for which there is a prescribed physician order. Staff stated that some residents take a nap or two during the day and no residents are being "drugged" to keep them asleep. Staff indicated that some residents do take a sleeping medication or anxiety medication, causing drowsiness, but is taken at bedtime only. Administrator stated that residents are "never chemically restrained". Medications were reviewed for (5) residents on 4/4/23, and it was determined that all medications are being administered as ordered with were no discrepancies found. (3) residents interviewed stated staff gives them ordered medications only, no residents appears to be "drugged" and forced to be sleeping and all residents are awake and up for breakfast.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Allegation: Facility staff not fingerprint-cleared. Complaint alleges that some staff are undocumented and are not finger-print cleared. LPA reviewed staffing records and schedules and confirmed that all staff are finger-print cleared and associated to the facility. In addition, LPA confirmed multiple staff's identity from a photo ID or passport.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Allegation: Staff are using drugs while on duty. Complaint alleges that staff are using drugs while on duty. All staff interviewed stated no staff are under the influence of alcohol r any drug that would prevent them from providing care and supervision to the residents. All residents (3) interviewed stated that staff provide excellent care, they are nice and caring people that do everything they can to make residents comfortable.
LPA observed staff to be competently assisting residents and able to perform their jobs on 4/20/23 and during other recent inspections in February 2023 and in October 2022.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.
cont on 9099C(2)...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 59-AS-20230328174657

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: ROBERT CREEK VILLA	FACILITY NUMBER: 345002857
	VISIT DATE: 04/20/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

9099C(2).. Allegation: Facility staff are abusing residents. Complaint alleges that staff are abusing residents with no specific details provided.

All staff stated that no staff has ever been observed to abuse any resident and that all staff are doing a great job in providing care and supervision to residents. Administrator stated there is absolutely no abuse of any kind at the facility. All residents (3) interviewed asserted that there is no abuse from staff and all staff provide good care to residents and the facility is a "good place". LPA observed staff to be competently assisting residents and able to perform their jobs on 4/20/23 and during other recent inspections in February 2023 and in October 2022.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

All allegations were determined to be unfounded.

There are deficiencies cited and the complaint is being dismissed.

Exit interview. Copy of report provided to Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3