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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345002884
Report Date: 07/16/2024
Date Signed: 07/23/2024 11:35:40 AM

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
06/21/2024 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20240621113310
FACILITY NAME:CARE HORIZONS IIFACILITY NUMBER:
345002884
ADMINISTRATOR:IORDACHE, DRAGOS ADRIANFACILITY TYPE:
740
ADDRESS:6640 CARE LANETELEPHONE:
(916) 229-7154
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 5DATE:
07/16/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Adrian IordacheTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Staff did not prevent a resident from causing harm to another resident
INVESTIGATION FINDINGS:
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13

LPA Parks arrived on Tuesday July 16, 2024, to conclude a complaint investigation regarding the above allegation. LPA met with Administrator Adrian and explained the purpose of the visit.

Throughout the course of the investigation, LPA interviewed the Administrator, R1-R4. LPA reviewed R1 and R2’s facility files.

LPA learned R1 has a diagnosis of schizoaffective and bipolar disorder. R2 has a diagnosis of Dementia. LPA interviewed both residents. R2 could not recall any event where there was an altercation with R1. R1 stated that R2 began to kick the facility dog. R1 then stated that R2 grabbed their hand. Later in the conversation, R1 stated that R2 kicked their leg and did not grab their hand. Both R1 and R2 stated that they were friends. On a follow-up visit, R1 acknowledged that they had a misunderstanding with R2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
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 2
Control Number 59-AS-20240621113310
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: CARE HORIZONS II
FACILITY NUMBER: 345002884
VISIT DATE: 07/16/2024
NARRATIVE
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Based on information obtained during the investigation, LPA finds the allegation to be UNSUBSTANTIATED- a finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

Exit interview. A copy of this report was emailed to the Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2