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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347000389
Report Date: 08/29/2024
Date Signed: 08/29/2024 11:22:09 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
07/16/2024 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20240716102800
FACILITY NAME:ATRIA EL CAMINO GARDENSFACILITY NUMBER:
347000389
ADMINISTRATOR:GEORGES, NATASHAFACILITY TYPE:
740
ADDRESS:2426 GARFIELD AVETELEPHONE:
(916) 488-5722
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:325CENSUS: DATE:
08/29/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Natasha GeorgesTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Staff is not meeting the needs of the residents
INVESTIGATION FINDINGS:
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On 8/29/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to deliver the findings on the allegation cited above. LPA met with Executive Director and explained the purpose of the visit.

During the course of this investigtaion, LPA conducted extensive interviews and file revies.

The result finding of the allegation is as follow on LIC 9099-C.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
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-20240716102800
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: 08/29/2024
NARRATIVE
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LIC 9099-C

Allegation: Staff is not meeting the needs of the residents.

The Department conducted interviews regarding the allegation above. Based on interview conducted with Executive Director, it revealed that R1 had an incident in the restroom and R1 thought the pendant was pressed for help. Interview further revealed that in the restroom there is a pull cord that triggers a help signal but R1 did not use it nor did R1 contacted the front desk for assistance via telephone. Executive Director stated a help signal training will be provided for residents in care. Interview further revealed that R1 is not in incontinence care where this was a rare occasion. Interview conducted with R2 revealed R2 has had no issues getting staff assistance. Interview conducted with R3 and R4 both revealed there is no concerns with their needs as staff are helpful. File review revealed that there was no record of R1's pendant was triggered during the time of the incident. File review further revealed that based on the calls triggered by R1's pendant from May 2024 to date of incident, the longest response time was four minutes. File review of R1's LIC 602A PHYSICIAN'S REPORT FOR RESIDENTIAL CARE FACILITIES FOR THE ELDERLY revealed that R1 has the capability for self care and is able to care for own toileting needs.

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, and a copy of the report was provided.

SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2