347001078-12-4-2023-27-AS-KHOS-CYEMVC-20231211085631

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001078
Report Date: 12/04/2023
Date Signed: 12/04/2023 04:30:06 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
09/27/2023 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230927090142

FACILITY NAME:	COURTYARD TERRACE		FACILITY NUMBER:	347001078
ADMINISTRATOR:	MAGDA LUIS		FACILITY TYPE:	740
ADDRESS:	3408 ALTA ARDEN EXPRESSWAY		TELEPHONE:	(916) 486-1281
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	40	CENSUS: 39	DATE:	12/04/2023
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Magda Luis		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff left resident soiled for an extended period of time.
Staff did not ensure resident's hygiene needs are being met.
Staff did not provide resident with clean clothing.
Staff does not ensure residents are provided daily activities.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to follow up on this complaint investigation. LPA Moleski met with facility administrator Magda Luis and explained the purpose of the visit.

This investigation consisted of interviews, observation, and record review.

During visits to this facility on 11/30/23 and on 12/4/23, LPA Moleski observed ongoing activities in an activities room. During these same visits, LPA Moleski observed residents to be clean and in clean clothes. LPA Moleski reviewed activities calendars and observed activities scheduled for each day. LPA Moleski observed a shower schedule and observed that showers are scheduled for each resident three times per week.

[continued on 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

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-20230927090142

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: COURTYARD TERRACE	FACILITY NUMBER: 347001078
	VISIT DATE: 12/04/2023

NARRATIVE

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LPA Moleski interviewed six residents (R1-R6) and six staff members (S1-S6). During these interviews, S6 said there were “problems” with the activities, but could not explain what they were. S6 said there are no toothbrushes for resident use. LPA Moleski checked three resident bedrooms at random on 12/4/23 and observed toothbrushes in each. S6 said residents’ diapers are sometimes not changed when they should be, but could not provide details as to who or why.

During an interview, R3 said that the activities provided were too simple for R3.

During interviews, S1-S5, R1-R2, and R4-R6 did not raise concerns regarding the allegations on this complaint.

The department has determined the following as it relates to the allegations that staff left a resident soiled for an extended period of time, that staff did not ensure a resident’s hygiene needs are being met, that staff did not provide a resident with clean clothing, and that staff does not ensure residents are provided daily activities:

Based on interviews, observation and record review, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Luis.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC9099 (FAS) - (06/04)

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