345002909-2-5-2025-59-AS-APEZ-DE8KZA-20250225072023

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002909
Report Date: 02/05/2025
Date Signed: 02/05/2025 04:47:54 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, 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
03/25/2024 and conducted by Evaluator Cassie Yang

COMPLAINT CONTROL NUMBER: 59-AS-20240325153758

FACILITY NAME:	COGIR OF FOLSOM		FACILITY NUMBER:	345002909
ADMINISTRATOR:	PHOEBIE CARCOT		FACILITY TYPE:	740
ADDRESS:	1801 EAST NATOMA STREET		TELEPHONE:	(916) 608-0800
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	66	CENSUS: 46	DATE:	02/05/2025
		UNANNOUNCED	TIME BEGAN:	09:56 AM
MET WITH:	Deborah Taylor		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff did not provide showers to residents in care
Staff did not ensure residents were kept clean
Staff did not provide transportation services to residents in care

INVESTIGATION FINDINGS:

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On February 5, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to deliver the findings of the allegations cited above.

LPA met with Executive Director and explained the purpose of the visit.

During the course of the investigation, the Department conducted interviews and file reviews.

The result of the allegations are to follow on LIC 9099-C(1).

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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-20240325153758

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: COGIR OF FOLSOM	FACILITY NUMBER: 345002909
	VISIT DATE: 02/05/2025

NARRATIVE

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LIC 9099-C(1)

Allegation: Staff did not provide showers to residents in care

Based on file review conducted for the facility shower sign off sheet for March 2024, it revealed residents in care was provided showers. Shower sign off sheet revealed R1 was showered total of nine (9) times on the following days in the month of March 2024: 2nd, 9th, 12th, 16th, 21st, twice on 22nd, 24th, and 27th. Shower sign off sheet revealed R2 was showered eight (8) times on the following days in the month of March 2024: 3rd, 4th, 6th, 10th, 13th, 17th, 21st, and 27th. Interview conducted with Executive Director on February 5, 2025 revealed since change of Executive Director, documentation has changed where facility will document on shower logs if there was any refusal and/or exceptions. Residents in care organized in scheduled showering schedules twice a week. The following allegation is unfounded.

Allegation: Staff did not ensure residents were kept clean

Based on interview conducted with Co-Reporting Party, it revealed Co-Reporting Party has observed residents in care having a dirty shirt on while eating or food on their faces. Co-Party Reporting stated that staff should utilize a bib for residents who are messy eaters. Interview conducted with Executive Director on April 3, 2024 revealed that there are a few residents in care who has mobility limitations with self-feeding. Executive Director stated facility cannot enforce residents in care to wear bibs. Executive Director stated after meals, staff assist with wiping food off resident’s clothing and may ask the residents if they want to change, but residents still have the rights to decline. Based on LPA's observation on April 3, 2024, facility staff were observed to be assisting residents in care with cleaning after meal. Interview conducted with Executive Director on February 5, 2025 revealed that facility are providing independent eaters with garment covers during meal times. The following allegation is unfounded.

Please continue on LIC 9099-C(2).

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20240325153758

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: COGIR OF FOLSOM	FACILITY NUMBER: 345002909
	VISIT DATE: 02/05/2025

NARRATIVE

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LIC 9099-C (2)

Allegation: Staff did not provide transportation services to residents in care.

Based on interview conducted with Executive Director on April 3, 2024, it revealed that the facility bus is utilizing for extracurricular activities such as city tours. Executive Director explained that the registration tag on the bus has expired therefore the bus cannot be utilized at this time. Executive Director stated that if residents in care needs transportation to medical and/or dental appointments family members are to pick up the resident from the facility to the appointment. If family members are unable to, facility staff can assist residents to an appointment when notified in advance and at an additional charge. Interview conducted with Executive Director and Health and Wellness Director on February 5, 2024 revealed that the facility bus is currently in the shop, but if residents in care are in need for transportation services, facility will provide third party transportation such as Heart of Gold. If family is unable to escort the residents then facility will schedule additional staff for escorting when notified in advance and with additional charge for the staffing. The allegation is unfounded.

Based on information obtained through interviews, file review and observation, the allegations listed above are UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted and a copy of the report was left at the facility.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC9099 (FAS) - (06/04)

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