347000985-9-16-2024-27-AS-LRIS-D97SDK-20240917134712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347000985
Report Date: 09/06/2024
Date Signed: 09/16/2024 03:22:55 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
05/08/2024 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240508104204

FACILITY NAME:	GOLDEN POND RETIREMENT COMMUNITY		FACILITY NUMBER:	347000985
ADMINISTRATOR:	AMANDA FRIEDMAN		FACILITY TYPE:	740
ADDRESS:	3415 MAYHEW ROAD		TELEPHONE:	(916) 369-8967
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95827
CAPACITY:	175	CENSUS: 78	DATE:	09/06/2024
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Ryan Nakao		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility staff not dispensing residents' medications as prescribed
Facility staff not responding to residents' call lights for over 30 minutes
Facility staff not meeting residents' incontinence care needs
Facility staff not providing commode to accommodate resident's needs

INVESTIGATION FINDINGS:

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On 09/06/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to delivery complaint findings. LPA met with Facility Designated Administrator (FDA), Ryan Nakao and explained the purpose of the visit.
Current census was 78. A brief interview with FDA Nakao was conducted.
Allegation: Facility staff not dispensing residents’ medications as prescribed
It was alleged that facility staff are not dispensing residents’ medications as prescribed. During the course of this investigation, this LPA reviewed facility documentation, conducted interviews, and observations. Based on interviewed conducted with 7 staff and 7 residents, 7 out 7 staff deny that residents medication was not provided as prescribed. 7 out 7 staff state that staff dispensing medication are provided medication as prescribed and always ensure that medication is provided based on what the prescription order states. 7 out 7 residents state that they do not have issues with the medication being provided to them as prescribed. LPA reviewed the facilities medication administration record from February 2024-April 2024.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: (916) 862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

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 27-AS-20240508104204

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: 09/06/2024

NARRATIVE

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It was observed that there were no discrepancies between the Medication Administrator Records and Physicians orders for all residents reviewed. In addition, this LPA conducted observation during medication pass. This LPA did not find any significant issues during medication pass. Based on the information gathered it is unclear if the facility staff was not dispensing residents’ medication as prescribed.

Allegation: Facility staff not responding to residents’ call lights for over 30 minutes

It was alleged that the facility staff are not responding to residents’ call lights for over 30 minutes. During the course of this investigation, this LPA reviewed facility documentation, conducted interviews, and observations. Based on interviews conducted with 7 staff and 7 residents, 7 out 7 staff deny that they are not responding to residents’ call lights for over 30 minutes. 7 out 7 staff state that some days might be harder to respond but there is not a time where resident’s are waiting for longer than 15 minutes. 7 out 7 staff also state that many times they forget to press the pendants to clear that they have responded. 7 out 7 residents deny waiting longer than 30 minutes when their call buttons are pressed. 7 out 7 residents state that staff arrive to their rooms within a reasonable time frame. A review of the facilities call button log shows that the facility averages response times from 5-28 minutes within the months of February 2024-April 2024. In addition, this LPA pressed call buttons of 4 residents and it was observed that response time was between 5 to 12 minutes within the 4 residents. Based on the information gathered it is unclear that the facility staff are not responding to residents’ call lights for over 30 minutes.

Allegation: Facility staff not meeting residents' incontinence care needs

It was alleged that the facility staff not meeting residents’ incontinence care needs. During the course of this investigation, this LPA conducted interviews and observations. Based on interviews conducted with 7 staff members and 7 residents, 7 out 7 staff members deny that they do not meet the residents’ incontinence care needs. 7 out 7 staff members state that they are able to meet their needs and change residents as needed and within a time frame if the resident is not soiled. 7 out 7 residents report that they do not have any issues and have not heard any issues about their incontinence needs not being met. LPA conducted a tour of the facility and facility resident rooms and did not observe any indication that the facility staff are not meeting the resident’s in continence needs. Based on the information gathered it is unclear if the facility staff are not meeting the residents incontinence needs.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: (916) 862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20240508104204

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: 09/06/2024

NARRATIVE

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Allegation: Facility staff not providing commode to accommodate resident's needs

It was alleged that the facility staff not able to accommodate resident’s needs. During the course of this investigation, this LPA conducted interviews and observations. Based on interviews conducted with 7 staff members and 7 residents, 7 out 7 staff members deny that they do not meet the residents’ care needs. 7 out 7 residents report that they do not have any issues and have not heard any issues about not being able to be accommodated with their needs at the facility. Based on the information gathered it is unclear if the facility staff are not able to accommodate resident’s needs.

Based on information provided through interviews and records reviewed, this allegation is deemed UNSUBSTANTIATED, meaning that there was not a preponderance of evidence to prove or disprove that the allegation occurred as reported.

There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: (916) 862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

LIC9099 (FAS) - (06/04)

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