345002909-3-12-2025-59-AS-APEZ-DEXLJX-20250320084840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002909
Report Date: 03/12/2025
Date Signed: 03/12/2025 01:15:18 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
03/14/2024 and conducted by Evaluator Cassie Yang

COMPLAINT CONTROL NUMBER: 59-AS-20240314145724

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: 44	DATE:	03/12/2025
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Deborah Taylor		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Staff do not respond to resident calls for assistance
Staff do not meet resident toileting needs
Staff did not seek medical attention for resident in a timely manner
Staff are not properly training to meet resident needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cassie Yang arrived to the facility 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 this investigation, LPA has conducted extensive interviews and file review for the allegations Staff do not respond to resident calls for assistance, Staff do not meet resident toileting needs, Staff did not seek medical attention for resident in a timely manner, and Staff are not properly training to meet resident needs.

Please continue on LIC 9099-C (1) for the result of the investigation.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

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-20240314145724

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: 03/12/2025

NARRATIVE

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LIC 9099-C (1)

Allegation: Staff do not respond to resident calls for assistance.

The Department conducted interviews and file review regarding the allegation. Based on interview conducted with R1 on March 22, 2024, it revealed R1 likes the staff at the facility. R1 stated staff are helpful and responds to calls as needed. R1 stated R1 has a slight cognitive impairment but is sharp for the most part. Interview conducted with Executive Director on April 3, 2024 revealed the call system is an alert at the front receptionist desk, which indicates which room is in need for assistance which receptionist then call caregivers to the room. Executive Director stated there is no systematic program that collects data of the alerts trigger by room cord plugs. Executive Director stated all rooms are installed with fall detection camera which will record videos of each fall, and alert the facility via telephone. File review of standard report of March 2024 call response data provided by room camera system revealed there was a total of 14 falls detected, the median time to respond was one minute and 14 seconds with the average time to respond to be one minute and 43 seconds. File review further revealed time to respond less than five minutes was the total of 92.31%. Interview conducted with Executive Director on February 5, 2025 revealed when a call for assistance is activated from a room, it will create a ring which cannot be deactivated until staff go to the resident room to turn it off when they respond. The allegation above is unfounded.

Allegation: Staff do not meet resident toileting needs.

Based on LPA's observation to seven bedrooms on April 3, 2024 and five bedrooms on June 21, 2024, there was no indication of incontinence mal odor. Interview conducted with R1 on March 22, 2024 revealed R1 does not have any issues with staff not fulfilling resident toileting needs. Interview conducted with R2 revealed R2 is happy and does not have any current issue regarding incontinence care. Interview conducted with Health and Wellcare Director revealed that she does not have any issues with staff not assisting residents with toileting and/or incontinence care. Health and Wellcare Director stated residents in care are changed and/or assisted with toileting needs before bed. Night (NOC) shift are not to disturb residents while they are sleeping to check their depends unless residents wake up in the middle of the night, and notify staff for a change. Health and Wellcare Director stated when morning shift starts it is usually when residents are waking up for the day which will require toileting/incontinence assistance. Residents may have had a bowel movement in their sleep at night but it does not mean residents were neglected. The allegation is unfounded.

Please continue on LIC 9099-C (2)

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20240314145724

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: 03/12/2025

NARRATIVE

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LIC 9099-C (2)

Allegation: Staff did not seek medical attention for resident in a timely manner.
Incident in question indicated that on February 26, 2024 during night shift, staff failed to seek medical attention for R1. Based on file review, it revealed on February 17, 2024 at approximately 9:10 p.m, R1 was vomiting after given PRN medication. Hospital documents revealed R1 was admitted to Mercy Hospital of Folsom for vomiting on February 17, 2024. File review of incident report submitted on February 28, 2024 revealed on February 25, 2024 at approximately 11 a.m, R1 informed staff R1 had an episode of emesis, and was transported to Mercy Hospital of Folsom for evaluation. During time of the faxed incident report, R1 has not been discharged from the hospital to the community. File review of R1's hospital documents confirmed R1 was admitted to the hospital on February 25, 2024. File review of submitted incident report revealed on March 11, 2024, R1 had an episode of emesis and was transported to Mercy Hospital of Folsom for evaluation. Hospital documents confirmed R1 was admitted to the emergency room on March 11, 2024. Therefore, the allegation is unfounded.

Allegation: Staff are not properly training to meet resident needs.
The Department conducted file review of medication training. File review revealed S1 was hired as an employee in August 2022, then scheduled for training to be a medication technician starting February 21, 2024. S1 completed the mandated training of 8 hours of instruction on February 23, 2024 and completed 16 hours of hands-on shadowing training on February 27, 2024. S2 was hired as an employee in December 2023, and completed the mandated medication administration training of 8 hours of instruction on January 1, 2024 and completed 16 hours of hands-on shadowing training on February 27, 2024. S3 was hired as an employee in December 2023, and completed the mandated medication administration training of 8 hours of instruction in February 2024 and completed 16 hours of hands-on shadowing training on December 31, 2024. Therefore, the allegation is unfounded.

Based on information obtained through file review and interviews, 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: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC9099 (FAS) - (06/04)

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