345002909-6-21-2024-59-AS-APEZ-D7NMXE-20240730095948

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002909
Report Date: 06/21/2024
Date Signed: 06/21/2024 03:16:59 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
04/02/2024 and conducted by Evaluator Cassie Yang

COMPLAINT CONTROL NUMBER: 59-AS-20240402165409

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: 22	DATE:	06/21/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Davina Barker		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility did not notify responsible person of an increase in monthly rent rates.

INVESTIGATION FINDINGS:

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On 06/21/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to deliver the findings for the allegation cited above. LPA met with Executive Director, Davina Barker, and explained the purpose of the visit.

Duirng the course of the investigtaion, LPA conducted file review and interviews.

Result is as follow, please see LIC 9099-C.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie Yang	TELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

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-20240402165409

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: 06/21/2024

NARRATIVE

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Allegation: Facility did not notify responsible person of an increase in monthly rent rates.
The Department conducted an extensive file review regarding the allegation above. Based on file review conducted, a letter of Annual Care Level Rate Adjustment Notice was provided to responsible party on October 31, 2023 with effective date of January 1, 2024. File review revealed that care service for Level 1 is $2550, with additional care level at $600. File review additionally revealed a reassessment service plan was conducted on 01/03/2024 by Health and Wellcare Director Nurse where R1's level of care changed from Memory Care 02 to Memory Care 06. Document revealed that responsible party signed the updated service plan on 01/18/2024. File review revealed on 03/08/2024, a letter was addressed to responsible party to inform of annual base rent increase from $4875 to $5216, effective date of 06/01/2024.

File review further revealed in Levels of Care Price list, Memory Care Level 2 ranged from 426 to 525. Memory Care Level 6 ranged from 826 to 925. File reviewed revealed in the initial assessment conducted on 06/23/2023, grand total of R1's care was 590. In most updated assessment conducted 01/03/2024, grand total of R1's care was 940.

Based on information above, the department concluded that the allegation is unfounded. A finding that an allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

No deficiencies cited.

Exit interview was conducted.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie Yang	TELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC9099 (FAS) - (06/04)

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