347000389-4-20-2022-25-AS-MSEY-CDQV75-20220422161035

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347000389
Report Date: 04/20/2022
Date Signed: 04/20/2022 04:54:42 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/12/2022 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220412100354

FACILITY NAME:	ATRIA EL CAMINO GARDENS		FACILITY NUMBER:	347000389
ADMINISTRATOR:	KIMBERLY HAGEN		FACILITY TYPE:	740
ADDRESS:	2426 GARFIELD AVE		TELEPHONE:	(916) 488-5722
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	325	CENSUS: 180	DATE:	04/20/2022
		UNANNOUNCED	TIME BEGAN:	02:49 PM
MET WITH:	Kimberly Hagen, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility is not abiding to admission agreement

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to commence a complaint investigation. LPA met with Kimberly Hagen, Administrator. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN95 mask.

During today's inspection, LPA discussed allegation with Kimberly Hagen, Administrator, Ingrid Weber, Memory Care Director and Deborah Ahrens, Business Office Director and reviewed pertinent documentation pertaining to resident (R1),including: care plan, Residency Agreement, and Room Change Addendum to the Residency Agreement.

The results of the investigation are as follows:

cont on 9099C..

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

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 25-AS-20220412100354

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: ATRIA EL CAMINO GARDENS	FACILITY NUMBER: 347000389
	VISIT DATE: 04/20/2022

NARRATIVE

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Interview with Executive Director confirmed that resident (R1) moved from Assisted Living to Memory Care on 1/27/2020 and the monthly costs were increased only at that point, due to resident's increase need for care/supervision. Executive Director reviewed monthly electronic billing statements with LPA which showed a cost of care increase effective 1/27/2020 when resident moved from Assisted Living to Memory Care.

LPA reviewed resident's Residency Agreement which states that when there is a change in the level of care, resident will be consulted with at the time of the change in the level of care. Agreement notes that the resident's responsible person will also be informed of any changes. Residency Agreement also explains how the assessment level is determined for a resident in memory care and denotes it as "Alz 1" or
"Alz 2 and lists the additional charge for each level. Resident signed the Residency Agreement on 4/24/2019 as resident's own responsible person.

Interview with Memory Care Director revealed that resident remained at Level 1 the entire time while residing in Memory Care and resident was "still physically able to move around with a walker and needed minimal assistance with care" and had many lucid moments. Resident's care plan, dated 11/17/2021, shows a care point that was for Level 1.

LPA reviewed documentation entitled " Room Change Addendum to El Camino Gardens Residency Agreement" , signed on 1/23/2020 by resident, noting that resident will be charged for Alz 1 Level of Care and Basic Services upon moving to the new apartment on 1/23/2020.

Based on information obtained during the investigation, LPA finds the allegation to be UNFOUNDED- A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted. Copy of report provided to Executive Director.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

LIC9099 (FAS) - (06/04)

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