347000389-8-11-2023-25-AS-LMUZ-CUPVYR-20230814165134

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347000389
Report Date: 08/11/2023
Date Signed: 08/11/2023 04:33:20 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
01/31/2023 and conducted by Evaluator Cassie Yang

COMPLAINT CONTROL NUMBER: 25-AS-20230131141449

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: 197	DATE:	08/11/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Kim Hagen		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Facility is unsanitary.
Staff do not ensure that the facility is free from pests.

INVESTIGATION FINDINGS:

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On 08/11/2023, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to deliver the findings of the allegations cited above. LPA met with Executive Director, Kimberly Hagen, and explained the purpose of the visit.

During the investigation, LPA conducted interviews and inspection of the facility. LPA is unable to find and or meet the preponderance, per policy.

The results of the investigation are as follows:

** Report continued on 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: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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-20230131141449

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: ATRIA EL CAMINO GARDENS	FACILITY NUMBER: 347000389
	VISIT DATE: 08/11/2023

NARRATIVE

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Allegation: Facility is unsanitary.
The Department conducted interviews to investigate this allegation. During interview conducted with S1 on 02/08/2023, S1 informed LPA the bistro is cleaned after each shift and trash are thrown out daily. Based on LPA’s observation on 02/08/2023 and 05/04/2023, LPA observed the bistro to be clean and sanitary.

Allegation: Staff do not ensure that the facility is free from pests.
The Department conducted interviews to investigate this allegation. During interview conducted with S1 and S2 on 02/08/2023, LPA was informed there is no concerns of cockroach and/or pest in the kitchen. LPA was informed by S1 that during the duration of S1’s employment, S1 has not seen any cockroaches presence in the bistro kitchen. On 2/8/2023 and 5/4/2023, LPA inspected the kitchen space in areas included but not limited to: under the refrigerator, freezer, fryer, and inside storage room, LPA did not observe presence of pests.

During this investigation, LPA conducted records review and extensive interviews. LPA found the facility to be compliance with Title 22. Based on interviews conducted, the preponderance of evidence standards have not been met. Based on information obtained during the investigation, LPA finds the allegations 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 and appeal rights was provided to Executive Director.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie Yang	TELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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, 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
01/31/2023 and conducted by Evaluator Cassie Yang

COMPLAINT CONTROL NUMBER: 25-AS-20230131141449

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: 197	DATE:	08/11/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Kim Hagen		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Staff serve residents moldy food.
Facility staff do not follow proper hand washing procedures.

INVESTIGATION FINDINGS:

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Unsubstantiated

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: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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-20230131141449

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: ATRIA EL CAMINO GARDENS	FACILITY NUMBER: 347000389
	VISIT DATE: 08/11/2023

NARRATIVE

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Allegation: Staff serve residents moldy food.
The Department conducted interviews to investigate this allegation. During interview conducted with S1 and S2 on 02/08/2023, LPA was informed that all food are labeled and discarded after the third day. LPA was informed that some sauce are made of herbs, that residents have mistaken it to be green mold. During interview conducted on 05/04/2023 with ED, LPA was informed a resident had complained about her cheese. LPA was informed by ED that the cheese served was blue cheese.

Facility staff do not follow proper hand washing procedures.
The Department conducted interviews to investigate this allegation. During interview conducted with S1 and S2 on 02/08/2023, S1 and S2 both informed LPA that the kitchen protocol is to wash hands prior to putting on gloves for prepping. During interviews, LPA was informed there are handwashing signs posted in the kitchen and restrooms for staff to follow.

Based on interviews conducted, the preponderance of evidence standards have not been met. Therefore, the above allegations are 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 and appeal rights was provided to Executive Director.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie Yang	TELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4