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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920099
Report Date: 09/26/2024
Date Signed: 09/26/2024 11:40:30 AM

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
05/30/2024 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 59-AS-20240530151725
FACILITY NAME:SPRING AZURE SENIOR CAREFACILITY NUMBER:
345920099
ADMINISTRATOR:CHUA-HARRIS, CHRISTINE DYAFACILITY TYPE:
740
ADDRESS:6924 OAK SPRING WAYTELEPHONE:
(916) 579-9222
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 5DATE:
09/26/2024
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Administrator, Dyan Christine Chua-HarrisTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility is not ADA accessible.
Staff not providing a safe environment for resident(s).
INVESTIGATION FINDINGS:
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On 09/26/24, Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Graham Gunby arrived at the facility unannounced to deliver final findings Community Care Licensing (CCL) received on 05/30/24. LPA met with Administrator, Dyan Christine Chua-Harris and explained the purpose of the visit.

During the course of the investigation, the Department conducted interviews and obtained pertinent documents relevant to the complaint investigation.

Please continue to LIC9099-C..
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
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-20240530151725
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: SPRING AZURE SENIOR CARE
FACILITY NUMBER: 345920099
VISIT DATE: 09/26/2024
NARRATIVE
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Allegation- Facility is not ADA accessible. -UNFOUNDED

The department conducted record review and interviews with staff and residents to investigate this allegation. During staff interviews, Administrator stated that facility has approved emergency disaster plan and was not ADA compliant (Americans with Disabilities Act Standards for Accessible Design) as it is not a requirement. Record review indicated that facility has Approved Fire Evacuation plan and Approved Facility’s sketch by local fire department per requirement. Department observed that facility was in compliance of Approved Fire plan for facility’s operations and there were no issues. From gathered information, it has been concluded that facility was operating under RCFE Title 22 Regulations which does NOT require facility to follow ADA guidelines, therefore this allegation was found to be UNFOUNDED.

Allegation- Staff not providing a safe environment for resident(s). -UNFOUNDED

Department conducted record review and interviews with staff and residents to investigate this allegation. It was alleged that facility’s main hallway and backyard area was not safe to meet resident’s medical transportation needs. Residents and staff interviews conducted on 06/04/24 indicated that resident, R1 was scheduled to go for doctor’s appointment on 05/30/24 in private ambulance on gurney which was arranged by facility. When the driver came to pick up R1, driver assessed that facility’s main hallway and backyard area was not safe for gurney transport and left the facility without taking R1. After that, facility called another private ambulance company who came and assisted R1 on gurney and transport R1 to their doctor’s appointment without any issues. During R1s interview on 06/04/24, R1 did not express any concerns with staff’s care or safety at the facility. Department observed that facility was providing safe environment to all residents without any issues. Based on gathered information, this allegation was found to be UNFOUNDED.

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

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2