<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347000389
Report Date: 03/02/2023
Date Signed: 03/02/2023 03:07:52 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/10/2022 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 25-AS-20221110111555
FACILITY NAME:ATRIA EL CAMINO GARDENSFACILITY NUMBER:
347000389
ADMINISTRATOR:KIMBERLY HAGENFACILITY TYPE:
740
ADDRESS:2426 GARFIELD AVETELEPHONE:
(916) 488-5722
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:325CENSUS: 179DATE:
03/02/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Kimberly Hagen, Executive DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not taking precautions for COVID-19
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Executive Director, Kimberly Hagen, to deliver findings into the allegation listed above. LPA wore a surgical mask. Facility staff wore masks while on the premises.

During the investigation, LPA conducted interviews.

The results of the investigation are as follows:

Allegation: Staff are not taking precautions for COVID-19

** Report continued on 9099-C **
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
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 4
Control Number 25-AS-20221110111555
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: ATRIA EL CAMINO GARDENS
FACILITY NUMBER: 347000389
VISIT DATE: 03/02/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Relevant party indicated that staff are not wearing masks while on the premises, that visitors are entering the facility from entrances that are not the one central entry point for COVID-19 screening, and 1 resident who was COVID-19 positive was not staying in isolation and entered the lobby area with other residents when they were supposed to be in isolation.

Interviews conducted with residents R1, R2, R3, R4, R5, R6, and R7, staff members S1, S2, S3, S4, S5, S6, S7, S8, and S9, and Executive Director (ED) indicated that staff wear masks while inside the facility. LPA observed staff wearing masks while inside the facility during visits conducted on 11/17/2022, 12/14/2022, 12/22/2022, 1/18/2023, 1/31/2023, 2/2/2023, 2/9/2023, 2/23/2023, and 3/2/2023.

Interviews with residents R2, R3, R4, staff members S5, S6, S7, S8, and S9, and ED indicated that they have witnessed 1 resident who was COVID-19 positive leave their isolation room, but all witnesses indicated that resident was redirected back to their room once noticed by facility staff to be out of isolation.

Interviews with resident R4, staff members S6, S7, S8, and ED indicated that visitors have been witnessed entering the facility from entrances that are not the one central entry point for COVID-19 screening. However, all witnesses indicated that visitors are redirected to central entry point for COVID-19 screening when noticed by facility staff.

Interviews with residents R1, R2, R3, R4, R5, R6, R7 indicated that they have no concerns regarding the COVID-19 protocols of the facility.

Based on interviews conducted and observations, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted with Executive Director and a copy of this report was provided to the facility. The signature of the Executive Director on these forms acknowledges receipt of these documents.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/10/2022 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 25-AS-20221110111555

FACILITY NAME:ATRIA EL CAMINO GARDENSFACILITY NUMBER:
347000389
ADMINISTRATOR:KIMBERLY HAGENFACILITY TYPE:
740
ADDRESS:2426 GARFIELD AVETELEPHONE:
(916) 488-5722
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:325CENSUS: 179DATE:
03/02/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Kimberly Hagen, Executive DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not conducting response testing due to COVID-19 outbreak
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Executive Director, Kimberly Hagen, to deliver findings into the allegation listed above. LPA wore a surgical mask. Facility staff wore masks while on the premises.

During the investigation, LPA conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

Allegation: Facility is not conducting response testing due to COVID-19 outbreak

** Report continued on 9099-C **
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 25-AS-20221110111555
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: ATRIA EL CAMINO GARDENS
FACILITY NUMBER: 347000389
VISIT DATE: 03/02/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Interviews with residents R1, R2, R3, R4, R5, R6, R7, staff members S1, S2, S3, S4, S5, S6, S7, S8, and S9, and ED indicated that themselves and others at the facility have participated in response testing for COVID-19 when there has been a COVID-19 outbreak on the premises. LPA received documentation regarding COVID-19 testing at the facility. LPA contacted a Sacramento County Public Health representative, who confirmed that the facility reported their most recent COVID-19 outbreak and has been reporting results from response testing.

Based on interviews conducted by LPA and documentation, the above allegation is found 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 was conducted with Executive Director and a copy of this report was provided to the facility. The signature of the Executive Director on these forms acknowledges receipt of these documents.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4