347000981-1-14-2025-27-AS-KHOS-DCXVGS-20250115152600

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347000981
Report Date: 01/13/2025
Date Signed: 01/14/2025 07:57:51 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
06/13/2024 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20240613111755

FACILITY NAME:	CARING FAMILIES-BV1		FACILITY NUMBER:	347000981
ADMINISTRATOR:	MACIAS, MICHELLE		FACILITY TYPE:	740
ADDRESS:	8712 BRAY VISTA WAY		TELEPHONE:	(916) 685-0404
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	6	CENSUS: 6	DATE:	01/13/2025
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Lorrena Lopez Goodenough		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff do not serve nutritious meals.
Staff are not meeting residents' dental hygiene needs.
Residents are left in soiled clothing.
Staff are not meeting residents' grooming needs.
Staff do not maintain accurate residents' records.
Staff do not ensure that residents' bathrooms are clean.
Staff do not notify responsible parties of incidents.

INVESTIGATION FINDINGS:

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THIS REPORT IS AMENDED TO REMOVE THE ADDITIONAL NUMBER (1) FROM DATES REFLECTING IT TO READ 1/13/25. ADMINISTRATOR AGREED

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conclude the investigation of the above-mentioned allegations on 1/13/25 at 8:45am. LPA met with Administrator Lorrena Lopez Goodenough, Administrator and stated the purpose of the visit.

Regarding allegation, “Staff do not serve nutritious meals”
During interviews of staff #1 (S1-S4) on 6/24/24 and 1/10/25 it was stated that the facilities main course which consists of a variety of foods is prepared off-site, and the sides are prepared on site. During interviews with responsible parties (RP1 – RP4) conducted on 1/13/25 revealed that there are a variety of meals and snacks provided for the residents. Based on interviews the preponderance of evidence standard has not been met.

Unsubstantiated

Estimated Days of Completion: 120

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025

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 3

Control Number 27-AS-20240613111755

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CARING FAMILIES-BV1	FACILITY NUMBER: 347000981
	VISIT DATE: 01/13/2025

NARRATIVE

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Regarding allegation, “Staff are not meeting residents' dental hygiene needs” During interviews of staff #1 (S1-S4) on 6/24/24 and 1/10/25 all corroborate that the residents all have hygiene care to include cleaning dentures in the morning and at night. During interviews with responsible parties (RP1 – RP4) conducted on 1/13/25 revealed that dental hygiene is being provided. One of the four responsible parties stated that hygiene could be better after meals. LPA observed the dentures of residents who are not using them during this time to be in denture cups with denture cleaning solution. Based on Observation and interviews the preponderance of evidence standard has not been met.

Regarding allegation, “Residents are left in soiled clothing” During interviews of staff #1 (S1-S4) on 6/24/24 and 1/10/25 LPA observed that S1 stated laundry is done daily. S2-S4 stated clothes are checked and changed when needed and that residents are not left in soiled items. LPA conducted unannounced visits on 6/14/24, 6/18/24, 7/11/24, 1/10/25 and 1/13/25 and did not observe a foul odor in the facility nor on residents during the visits. During interviews with responsible parties (RP1 – RP4) conducted on 1/13/25 revealed that during unannounced visits, residents are not being left in soiled clothing and there is no foul odor present. Based on observations and interviews the preponderance of evidence standard has not been met.

Regarding allegation, “Staff are not meeting residents' grooming needs” During interviews of staff #1 (S1-S4) on 6/24/24 and 1/10/25 LPA obtained information that the Chief Operating Officer (COO/S1) makes unannounced visits and finds the residents to be cared for and in good spirits. S2-S4 stated that residents have showers, skin care with lotion and facial hairs groomed. There is a schedule for everyone but sometimes residents refuse at which time another staff would try to assist in that area. LPA observed a copy of the shower schedule which indicates R1 gets a shower 3 times a week. LPA observed other facility records which document dates that residents receive showers, oral care, and weighed to determine weight gain or loss. During interviews with responsible parties (RP1 – RP4) conducted on 1/13/25 revealed that residents are receiving groom care with hair and nails. In regards to the nail care, the facility has a podiatrist who visits, some go out in the community, staff files nails, and some family assist with the nail care. Based on interviews the preponderance of evidence standard has not been met.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20240613111755

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CARING FAMILIES-BV1	FACILITY NUMBER: 347000981
	VISIT DATE: 01/13/2025

NARRATIVE

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Regarding allegation, “Staff do not maintain accurate residents' records” During interviews of staff #1 (S1-S4) on 6/24/24 and 1/10/25 LPA observed that staff are documenting Activities of Daily Living (ADLs) like medications, hygiene, bowel and urination, food, fluid, snacks, and weight. LPA observed facility records which document dates that residents receive showers, oral care, and weight gain or loss. During interviews with responsible parties (RP1 – RP4) conducted on 1/13/25 revealed that staff has been observed completing records or when asked has provided information regarding care from the records promptly. Based on interviews the preponderance of evidence standard has not been met.

Regarding allegation, “Staff do not ensure that residents' bathrooms are clean” During interviews of staff #1 (S1-S4) on 6/24/24 and 1/10/25 LPA obtained information that the bathrooms are cleaned as needed and on every shift. During interviews with responsible parties (RP1 – RP4) conducted on 1/13/25 revealed that the bathrooms have new accessible showers, and toilets and that the bathrooms contain necessary toiletries and are clean. Based on interviews the preponderance of evidence standard has not been met.

Regarding allegation, “Staff do not notify responsible parties of incidents” During interviews of staff #1 (S1-S4, S6) on 6/24/24 and 1/10/25 LPA observed that according to S6 some families are not responsive. S2-S4 stated that responsible parties are either contacted by the caregivers, Administrator, or Chief Operating Officer (COO/S1) which includes contacting 911 when things are serious. During interviews with responsible parties (RP1 – RP4) conducted on 1/13/25 revealed that all corroborate that staff are contacting them regarding incidents. Two out of the ten persons interviewed stated that contact was not made timely. A review of Incident reports submitted to Community Care Licensing indicate that staff is contacting the families and/or responsible parties regarding concerns with the residents. Based on interviews the preponderance of evidence standard has not been met.

Based on observations, interviews conducted, and records review, it was determined that the preponderance of evidence standard is not met, therefore the allegations are deemed UNSUBSTANTIATED. A finding of 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 incident occurred.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held. A copy of todays’ report provided.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025

LIC9099 (FAS) - (06/04)

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