347001715-1-10-2025-27-AS-KHOS-DCXUMX-20250115144301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001715
Report Date: 01/10/2025
Date Signed: 01/10/2025 12:34:55 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
06/13/2024 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20240613130943

FACILITY NAME:	CARING FAMILIES-BV2		FACILITY NUMBER:	347001715
ADMINISTRATOR:	MICHELLE MACIAS		FACILITY TYPE:	740
ADDRESS:	8716 BRAY VISTA WAY		TELEPHONE:	(916) 686-0420
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	6	CENSUS: 3	DATE:	01/10/2025
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Tamara Fitzpatrick		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff are not providing adequate assistance to residents while care.
Staff are not meeting resident's hygiene needs.
Staff are not meeting resident's nutritional needs.
Staff are not meeting resident's grooming needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 1/10/25 at 8:45AM to conclude the complaint investigation. LPA met with Lorrena Lopez Goodenough, Administrator and Tamara Fitzpatrick, CEO and explained the purpose of the visit. LPA interviewed resident #4 (R4-R5) and Staff #3 (S3-S4) during this visit.

Regarding allegation, “Staff are not providing adequate assistance to residents while care”
R1 Responsible Party stated that staff mentioned a sore on R1’s buttock.
R3 Responsible Party stated that R3 loves the home, staff is good at assisting R3.
R4 stated staff always assist and is much better than the last place.
R5 was interviewed but may not be a credible witness due to diagnosis of dementia
S1 stated assistance is provided for the care of the residents.
S2 stated unannounced visits revealed the residents are well cared for.
S3 stated all the residents received assistance.

Unsubstantiated

Estimated Days of Completion: 120

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 27-AS-20240613130943

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: CARING FAMILIES-BV2	FACILITY NUMBER: 347001715
	VISIT DATE: 01/10/2025

NARRATIVE

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A review of resident #1 (R1) Resident Activities of Daily Living (ADL) Log Sheet revealed that during 5/19/24- 6/15/24, R1 weighed 92-93lbs and that ADL’s were being provided.
The investigation revealed that staff used butt paste to prevent a pressure injury for R1 and interviews conducted on 6/24/24 indicate residents are receiving assistance with ADLs. The preponderance of evidence has not been met.
Regarding allegation, “Staff are not meeting resident's hygiene needs”
R1 Responsible Party stated that R1s teeth are never brushed.
R3 Responsible Party stated a few times R3 was not smelling well upon arrival for a visit, but staff handled it.
R4 stated I take care of my own as much as I can until I can't.
R5 was interviewed but may not be a credible witness due to diagnosis of dementia
S1 Traci stated one of the residents does hit and showers has been skipped until we can do it. R1 had a sore but cream was used on it, and R1 has dentures.
S2 stated residents are on a schedule and teeth and dentures are not dirty nor neglected.
S3 stated there is a shower schedule for everyone and after they get lotion.
A review of resident #1 (R1) Resident Activities of Daily Living Log Sheet revealed that during
5/19/24- 6/15/24, R1 received assistance with care needs such as oral, food, liquids, shower. LPA observed on the log indicates that there were only a few instances where R1 did not either have a bowel, shower, or oral care. R1 had a dedicated shower day on Tuesday and Saturday.
The investigation revealed that there is 1-2 staff on every shift and daily logs are being completed as to the hygiene practices in which staff is assisting. Interviews conducted on 6/24/24 indicate residents are receiving assistance with hygiene needs. The preponderance of evidence has not been met.
Regarding allegation, “Staff are not meeting resident's nutritional needs”
R1 Responsible Party stated that snacks are given.
R3 Responsible Party stated that they would eat the food because it passed the taste test, and R3 loves it.R3 Rp not aware.
R4 stated the food is edible and I like it. Its much better than the last place.
R5 was interviewed but may not be a credible witness due to diagnosis of dementia
S1 stated the food is made somewhere else and we add things like rice and vegetables. They make the main meal we add the sides.
S2 stated food is cooked fresh. The food has been observed during preparation and cooking process and there is 1 cook.
S3 stated R1 ate a lot even between meals. All the residents ate at the same time which was 5:30p

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20240613130943

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: CARING FAMILIES-BV2	FACILITY NUMBER: 347001715
	VISIT DATE: 01/10/2025

NARRATIVE

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A review of the meal menu for week 1-8 reveals that there is a variety of meals prepared for breakfast, lunch, and dinner
The investigation revealed that meal main course is being cooked off site and the side items are being prepared at the facility. Interviews conducted on 6/24/24 indicate residents are receiving food of good quality and quality as well as snacks between meals. The preponderance of evidence has not been met.

Regarding allegation, “Staff are not meeting resident's grooming needs”
R1 Responsible Party stated that it appears that staff tends to residents grooming needs.
R3 Rp stated there is no issue now but in 2023 it was but only that 1 time.
R4 stated the food is edible and I like it. Its much better than the last place.
R5 was interviewed but may not be a credible witness due to diagnosis of dementia
S1 stated residents’ teeth are brushed and R1 has dentures. There is one resident who doesn’t like it much.
S2 stated residents have shower schedules dressed and hair is brushed. Staff allow residents to do ADLs with assistance. When they refuse, there is an attempt to try again by another staff but never forced. Residents are not left with only a depend on without any other clothing.
S3 stated teeth were cleaned and dentures were put into a cup to be cleaned.
A review of resident #1 (R1) Resident Activities of Daily Living Log Sheet revealed that during
5/19/24- 6/15/24, R1 received assistance with care needs and R1 had a dedicated shower day on Tuesday and Saturday.
The investigation revealed that residents are receiving assistance with brushing their teeth and/or dentures when allowed by the residents. Interviews conducted on 6/24/24 and 1/10/25 indicate residents are receiving assistance with ADLs. The preponderance of evidence has not been met.

Based on interviews conducted on 6/24/24 and records review, it was determined that the preponderance of evidence standard is not met, therefore the allegation is UNSUBSTANTIATED. A 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 incident occurred.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held. A copy of todays’ report provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

LIC9099 (FAS) - (06/04)

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