347001289-6-20-2023-59-AS-MSEY-CTGSN6-20230706140059

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001289
Report Date: 06/20/2023
Date Signed: 06/20/2023 03:43:02 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
03/28/2023 and conducted by Evaluator Kevin Mknelly

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230328181753

FACILITY NAME:	ELDERLY INN I, THE		FACILITY NUMBER:	347001289
ADMINISTRATOR:	TOPLEAN, DANIELA		FACILITY TYPE:	740
ADDRESS:	5206 ROBERTSON AVENUE		TELEPHONE:	(916) 488-4518
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 3	DATE:	06/20/2023
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Caregiver		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Residents are chemically restrained with medication
Facility staff not fingerprint-cleared
Staff are using drugs while on duty
Facility staff are abusing residents

INVESTIGATION FINDINGS:

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On 6/20/23 , Licensing Program Analyst (LPA) Kevin Mknelly LPA Mknelly arrived and met with caregiver to deliver investigation findings.
LPA reviewed staff records and facility records.
Residents observed on 2 occasions to be active and engaged.
Observation, interviews and records reviews found no evidence of staff drug use, medication administration of medications as prescribed only, and no evidence of abuse of residents.
Employees are are all fingerprint cleared and associated.
LPA finds that facility met Tittle 22 requirements.
LPA advised licensee post a 2023 CA labor law poster.

This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.
Exit interview conducted and report provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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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