347000985-9-3-2025-27-AS-SRIN-DM3VC3-20251002161828

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347000985
Report Date: 09/03/2025
Date Signed: 09/03/2025 05:18:22 PM

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
09/03/2025 and conducted by Evaluator Kimberly Viarella

COMPLAINT CONTROL NUMBER: 27-AS-20250903122428

FACILITY NAME:	GOLDEN POND RETIREMENT COMMUNITY		FACILITY NUMBER:	347000985
ADMINISTRATOR:	RYAN NAKAO		FACILITY TYPE:	740
ADDRESS:	3415 MAYHEW ROAD		TELEPHONE:	(916) 369-8967
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95827
CAPACITY:	175	CENSUS: 89	DATE:	09/03/2025
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Ryan Nakao		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Licensee is not ensuring the resident's room is kept at a comfortable temperature.

INVESTIGATION FINDINGS:

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On 09/03/25, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to open an investigation into the above allegation. LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator/Executive Director. LPA met with Ryan Nakao and a brief interview followed.

Regarding the above allegation, on Saturday 08/30/25, the responsible party of resident (R1) was contacted by the private caregiver for R1 that the air conditioning (AC) in R1's room was not working and it was very hot. According to the Weather Channel, the outisde temperature in Sacramento that day was 102 degrees Fahrenheit. The RP called the front desk but could not contact anyone to assist. The private caregiver spoke with facility staff who notified maintenance about the problem. Maintenance staff (M1) responded to assess the situation. M1 could not fix the problem and contacted their supervisor (M2). M2 contacted the Executive Director and was given permission to relocate the resident to another room while they contacted the appropriate person to repair the air condioning in the resident's room. A repair person arrived that same day

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025

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-20250903122428

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: GOLDEN POND RETIREMENT COMMUNITY	FACILITY NUMBER: 347000985
	VISIT DATE: 09/03/2025

NARRATIVE

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and determined that the system needed a part that could not be ordered until Monday, but they would do so and return as soon as they received it on Tuesday, 09/02/25 or Wednesday, 09/03/25.

RP was offered the option of moving R1, they declined. In an interview with RP, they explained that R1 required certain adaptive medical furniture and since no one offered to move any of R1's furniture or belongings, they did not feel that R1 would be comfortable or able to function well in the other room. In interviews with M2 and the Executive Director, both stated that they offered to move R1's belongings, and that RP declined.

On Saturday, after declining to move, maintenance brought in a portable AC unit. During today's walkthrough, this LPA observed the portable AC unit in R1's room. It was not installed in a window or patio door opening. It was missing the flex tubing that is supposed to pull air from the outside. It was located just inside the apartment door and venting into the hallway. During my visit it was off, however in an interview with the RP, this LPA learned that when it was first brought in it was put near the open patio slider. It would blow cold air toward one area, however it was venting hot air into the rest of the apartment. As it was not installed in the slider, there was additional hot air coming into the room from that door-sized opening. This did not provide any consistent or comfortable temperature. The RP stated that it got too cold and that was why the unit was relocated to the doorway.

M2 provided this LPA with time stamped photos of temperature readings taken with the same type of thermometer that LPAs use in facilities. He recorded the following: 8/31/25 at 4:12 PM in the living room, and approximately 2 -3 feet away from the AC unit the temperature was 68 degrees Fahrenheit. At 4:13 PM the temperature in the bedroom measured 76 degrees Fahrenheit, by the television, it measured 70 degrees Fahrenheit. M2 and the RP had a conversation about R1's preferred temperature and on Tuesday 09/02/25, the temperature measured 76 degrees Fahrenheit in the bedroom.

M2 also showed the private caregiver how to adjust the temperature on the portable AC unit so that the resident could increase or decrease it for their comfort.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20250903122428

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: GOLDEN POND RETIREMENT COMMUNITY	FACILITY NUMBER: 347000985
	VISIT DATE: 09/03/2025

NARRATIVE

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The RP stated that on Tuesday at 10:58 AM the Executive Director (ED) offered to move R1 to the memory unit. The RP stated that R1 would need all of their adaptive equipment and they did not want R1 in the memory unit. The ED then offered to move R1 and their adaptive furniture to an empty room. At this point, the RP visited the facility and the room was 78 degrees and they were told that a repair person was coming within the next day or two. R1 was on hospice and the RP did not want to disrupt their life and belongings unless it was absolutely necessary.

Through interviews with M1 and M2, this LPA learned that repair people had been contacted, that one had come out to the facility and determined that there was a part they needed that could be ordered on Monday, 09/01/25 and the system was repaired earlier today on 9/3/25.

The facility did try to fix the issue with the air-conditioner when they first learned of it. They also offered to move the resident to a new room. They contacted a repair person and scheduled a maintenance visit. However, when they could not fix the AC right away and the resident did not wish to move to a new room, they brought in a portable air conditioner that did cool the room. The temperature was not consistent throughout the apartment, but the option to relocate to another room was provided. The standard for the preponderance of evidence was not met and therefore the Department found the above allegation to be UNSUBSTANTIATED.

A complaint allegation 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 violation occurred.

According to the California Code of Regulations, Title 22. No other deficiencies were observed or cited during today's visit. A copy of this report was provided along with APPEAL RIGHTS.

Exit interview.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025

LIC9099 (FAS) - (06/04)

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