347000389-5-1-2024-59-AS-APEZ-D59KG6-20240514075301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347000389
Report Date: 05/01/2024
Date Signed: 05/01/2024 11:11:36 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
09/20/2023 and conducted by Evaluator Cassie Yang

COMPLAINT CONTROL NUMBER: 59-AS-20230920125329

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: 185	DATE:	05/01/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Natasha Georges		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Illegal eviction
Staff did not provide resident's responsible party with resident's records.

INVESTIGATION FINDINGS:

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On 5/1/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to the facility to deliver the finding of the allegations cited above. LPA met with Executive Director, Natasha Georges, and explained the purpose of the visit.

The course of this investigation, LPA has conducted interviews and extensive file review.

Results are 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: 05/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024

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-20230920125329

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: 05/01/2024

NARRATIVE

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LIC9099-C

Allegation : Illegal eviction

The Department conducted interviews and file review of the following allegation. Interview conducted with Assistant Executive Director, it revealed that R1's rent has not been paid for an extensive amount of time. Interview further revealed that R1 had a professional fiduciary as Durable Power of Attorney who conducted financial abuse and neglected to pay R1's monthly rent. File review revealed the last payment made by R1's fiduciary was February 2022. File review further revealed R1 and responsible party was provided a copy of the 30 Day Notice To Pay Or Quit letter in April 2022, September 2022. Notice of Intent To File Unlawful Detainer Action was provided to R1 in November 2022 and Notice of Filing Unlawful Detainer Complaint was filed and provided to R1 in January 2023. File review further revealed Sacramento Sheriff Department provided a Notice to Vacate to R1. Therefore, the allegation is unfounded.

Allegation: Staff did not provide resident's responsible party with resident's records.

The Department conducted interviews regarding the allegation cited above. Interview conducted with Assistant Executive Director revealed that R1's responsible party had requested for R1's "medical records". Assistant Executive Director stated that the facility does not have access R1's medical records as only the hospital will have the following records. Interview further revealed that Resident Service Supervisor was asked to make copies of R1's LIC 602 Physician Report, original Physician Orders for Life-Sustaining Treatment (POLST) and medication list for R1's repsonaible party. Interview conducted with Resident Service Supervisor revealed that documents request was provided to R1's responsible party "several times". Interview further revealed that the documents provided was R1's LIC 602, medication list, tuberculosis test result. Additionally, in another occasion, LIC 602 was emailed to R1's responsible party. The allegation is unfounded.

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

Exit interview conducted, a copy of the report was provided.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie Yang	TELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024

LIC9099 (FAS) - (06/04)

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