347000985-11-8-2023-27-AS-LKIG-CXNSCB-20231117124516

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347000985
Report Date: 11/08/2023
Date Signed: 11/08/2023 12:32:04 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/12/2023 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20230612154407

FACILITY NAME:	GOLDEN POND RETIREMENT COMMUNITY		FACILITY NUMBER:	347000985
ADMINISTRATOR:	TRACY MCLINN		FACILITY TYPE:	740
ADDRESS:	3415 MAYHEW ROAD		TELEPHONE:	(916) 369-8967
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95827
CAPACITY:	175	CENSUS: 99	DATE:	11/08/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Amanda Friedmand		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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1) Medication: Staff did not give resident medication

Neglect/Lack of Supervision:
2) Facility did not address spread of scabies
3) Due to lack of supervision, residents would go into other resident's rooms

4) Personal Rights: Staff did not safeguard resident's belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Golden Pond Retirement Community (RCFE) on 11/8/23 at 9:00am to conclude the investigation of the above allegations and to deliver the findings. LPA met with Administrator and together discussed the investigation details.

Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated. LPA conducted interviews with six staff members and reporting party (RP). LPA conducted records review for alleged victim and requested documentation from reporting party. Based on the files reviewed during the inspections, LPA could not corroborate the allegations regarding medication administration. LPA observed as that resident was placed in the facility on 7/25/23 with no medication order medication identified as not provided and no record of medication described prior to alleged victims placement at the facility. LPA observed that after several days at the facility resident was provided new prescription and was followed by the facility as evidenced by medication administration records.
Report Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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 27-AS-20230612154407

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: GOLDEN POND RETIREMENT COMMUNITY	FACILITY NUMBER: 347000985
	VISIT DATE: 11/08/2023

NARRATIVE

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Regarding allegation facility did not address spread of scabies, LPA reviewed facility records and conducted staff interviews. LPA was able to determine there was no identified scabies outbreak at the facility. Facility records provided showed only one resident was diagnosed with scabies at the facility. Other resident's identified as possibly having scabies were determined to be other skin rashes or were not diagnosed by a physician and only received medications to treat/prevent spread of scabies. Staff interviewed all provided detailed procedures and enhanced infection control actions such as use of PPE, enhanced cleaning and changes to laundry services to prevent the transmission of infectious disease. LPA could not obtain a preponderance of evidence to support the allegation.

Regarding the safeguarding of belongings and addressing resident's wandering to other rooms. LPA conducted interviews with 6 staff members and RP. LPA's record review of resident's records showed the authorized representative waived and signed the Resident's personal property inventory. LPA was unable to obtain any documentation of items the resident may have had in her possession prior to leaving the facility. Additionally, LPA was unable to obtain any documentation for items that have been returned to RP that did not belong to resident or belonged to another resident at the facility and was incorrectly provided to RP. LPA reviewed the theft loss policy binder at the facility and observed no documentation of resident's alleged missing items. Staff interviews demonstrated the facility policies and procedures for addressing resident behavior such as wandering to other rooms and "shopping" in other resident rooms. Facility staff state they rely on family to label resident's clothing to ensure it is retained by the resident. if clothing items are presented to resident staff they will label a resident's clothing. Facility staff provided LPA with procedures followed to ensure resident's are redirected appropriately and items not belonging to resident's are returned to proper resident.

Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has determined that the allegations of Personal Rights, Medication and Neglect/Lack of Supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies noted or cited per California Code Regulation, TITLE 22.

Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

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