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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347002967
Report Date: 10/31/2023
Date Signed: 10/31/2023 09:45:15 AM

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
08/23/2023 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230823121255
FACILITY NAME:MELINDA'S CARE HOMEFACILITY NUMBER:
347002967
ADMINISTRATOR:MUNAR, MELINDAFACILITY TYPE:
740
ADDRESS:8216 COTTONBALL WAYTELEPHONE:
(916) 761-1150
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 3DATE:
10/31/2023
UNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:Desenia ArroganteTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident has unexplained bruising
Due to staff neglect, resident has lost weight
Staff are not allowing resident enough time to finish meals
Staff are not assisting resident with oral hygiene
Staff are not keeping the facility at a comfortable temperature
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/31/2023 at 8:08 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with direct care staff, Desenia Arrogante and explained the purpose of the visit. Care staff then called the administrator, Melinda Munar and LPA Lee spoke to administrator and explained purpose of this visit is to deliver complaint findings for the allegations above. LPA Lee read the findings to administrator via telephone. The current census is 3 resident and 1 facility staff.

Allegation: Resident has unexplained bruising
It was alleged that the resident had unexplained bruising. This investigation consisted of records reviewed, interviews with staff, residents, resident responsible party, and outside agencies. LPA Lee interviewed 3 out of 3 residents who have no concern regarding facility staff and that the resident felt safe living in this home. Through the course of the investigation, it was learned that resident 1 (R1) has experienced multiple falls and that (R1) can get bruised easily if (R1) hits anything by accident. In addition, (R1) denies facility is causing (R1) brushing and 3 out 3 facility staff also deny that (R1) brushed is caused by the facility staff. Furthermore, it was learned that 3 out of 3 outside agencies cannot confirm that resident bruise was caused by facility staff. On 08/25/203 and 09/21/2023 complaint visit LPA Lee did not observe other residents having bruised on residents’ arm and leg.
Continued LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
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 5
Control Number 27-AS-20230823121255
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: MELINDA'S CARE HOME
FACILITY NUMBER: 347002967
VISIT DATE: 10/31/2023
NARRATIVE
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Based on information provided through interviews and records reviewed, the allegation is deemed UNSUBSTANTIATED although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation resident has unexplained bruising.
Allegation: Due to staff neglect, resident has lost weight

It was alleged that due to staff neglect, residents have lost weight. This investigation consisted of records reviewed, interviews with staff, residents, resident responsible party, and outside agencies. LPA Lee interviewed 3 out of 3 residents who have no concern regarding facility staff and that resident felt safe living in this home. Through the course of the investigation, it was learned that resident 1 (R1) was admitted to UC Davis Hospital from 07/03/2023 to 07/10/2023 and was at 144 pounds and 1 ounce. When (R1) was discharged from UC Davis Hospital (R1) was placed at another RCEF facility and from that RCFE facility resident was then placed at Melinda Care Home on 07/29/2023. It was learned that when residents came to Melinda Care Home resident weight was not taken. Resident then was admitted back to UC Davis on 08/22/2023 at the weight of 133 pounds and 6.1 ounce. In addition, it was learned that 3 out of 3 outside agencies cannot confirm that resident weight loss was caused by facility staff. Furthermore, (R1) denies that facility staff caused resident weight loss and 3 out of 3 facility staff denies the allegations.

Based on information provided through interviews and records reviewed, the allegation is deemed UNSUBSTANTIATED although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation due to staff neglect, resident has lost weight.

Allegation: Staff are not allowing resident enough time to finish meals

It was alleged that staff are not allowing residents enough time to finish meals. This investigation consisted of records reviewed, interviews with staff, residents, and observations. LPA Lee interviewed 3 out of 3 residents who have no concern regarding facility staff not allowing residents enough time to finish meals. It was learned that breakfast runs between 7:00 AM to 8:00 AM, lunch from 11:00 AM to 12:00 PM and dinner from 4:00 PM to 5:00 PM; however, residents can take as long as needed to finish each meal. On 08/25/23, LPA Lee observed lunch and residents were able to finish lunch with no rush. On 09/21/2023 LPA Lee observed resident eating breakfast and resident was able to finish breakfast with no rush as well.

Based on information provided through interviews and records reviewed, the allegation is deemed UNSUBSTANTIATED although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation staff are not allowing resident enough time to finish meals.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20230823121255
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: MELINDA'S CARE HOME
FACILITY NUMBER: 347002967
VISIT DATE: 10/31/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff are not assisting resident with oral hygiene

It was alleged that staff are not assisting residents with oral hygiene. This investigation consisted of records reviewed, interviews with staff, residents, resident responsible party, and outside agencies. LPA Lee interviewed 3 out of 3 residents who have no concern regarding facility staff not assisting residents with oral hygiene. It was learned through the investigation that residents are given resident toothbrushes and toothpaste and encouraged to brush residents’ teeth. It was also learned that facility staff assist residents with brushing their teeth if needed. In addition, (R1) denies the allegations as well as 3 out of 3 facility staff denies the allegations.

Based on information provided through interviews and records reviewed, the allegation is deemed UNSUBSTANTIATED although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation staff are not assisting resident with oral hygiene.

Allegation: Staff are not keeping the facility at a comfortable temperature

It was alleged that Staff are not keeping the facility at a comfortable temperature. This investigation consisted of records reviewed, interviews with staff, residents, and observations. LPA Lee interviewed 3 out of 3 residents who have no concern with the facility temperature. On 08/25/2023 open complaint visit, LPA Lee observed the facility thermostat measured at a 75 degrees Fahrenheit. On 09/21/2023 during a complaint follow-up visit, LPA Lee observed the facility thermostat measured at 72 degrees Fahrenheit. Moreover, during both complaints visit LPA Lee observed the facility temperature to be comfortable.

Based on information provided through interviews and records reviewed, the allegation is deemed UNSUBSTANTIATED although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation staff are not keeping the facility at a comfortable temperature.

An exit interview was conducted with care staff, Desenia Arrogante and a copy of this report was left with care staff.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
08/23/2023 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230823121255

FACILITY NAME:MELINDA'S CARE HOMEFACILITY NUMBER:
347002967
ADMINISTRATOR:MUNAR, MELINDAFACILITY TYPE:
740
ADDRESS:8216 COTTONBALL WAYTELEPHONE:
(916) 761-1150
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 3DATE:
10/31/2023
UNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:Desenia ArroganteTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff have resident sleep in a converted garage
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/31/2023 at 8:08 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with direct care staff, Desenia Arrogante and explained the purpose of the visit. Care staff then called the administrator, Melinda Munar and LPA Lee spoke to administrator and explained purpose of this visit is to deliver complaint findings for the allegations above. LPA Lee read the findings to administrator via telephone. The current census is 3 resident and 1 facility staff.

Allegation: Staff have resident sleep in a converted garage
It was alleged that staff have residents sleep in a converted garage. This investigation consisted of records reviewed, interviews with staff, residents, and observations. Through the investigation it was learned that when the facility fire inspection was conducted on 09/26/2005 fire clearance was granted. Moreover, it was also learned that the facility sketch does have the converted garage licensed as a non-ambulatory resident room.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20230823121255
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: MELINDA'S CARE HOME
FACILITY NUMBER: 347002967
VISIT DATE: 10/31/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on information provided through interviews and records reviewed, the allegation is deemed Unfounded, meaning that the allegation was false, could not have happened and/or was without a reasonable basis.

An exit interview was conducted with care staff, Desenia Arrogante and a copy of this report was left with care staff.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5