347003117-7-13-2023-27-AS-CACL-CTWM2E-20230720091323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347003117
Report Date: 07/13/2023
Date Signed: 07/13/2023 08:45:03 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/22/2023 and conducted by Evaluator Avelina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230222092020

FACILITY NAME:	APPLE RIDGE ASSISTED LIVING		FACILITY NUMBER:	347003117
ADMINISTRATOR:	MICHELLE HARDY		FACILITY TYPE:	740
ADDRESS:	3950 ANNADALE LANE		TELEPHONE:	(916) 489-6900
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95821
CAPACITY:	82	CENSUS: 60	DATE:	07/13/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Ashley Sylve		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

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Staff did not clean residents' bathroom.
Staff are not following Physician's orders.
Staff are not re-ordering medication timely.

INVESTIGATION FINDINGS:

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On 07-13-2023 at 8:20 AM, Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced facility visit to deliver complaint findings. LPA Martinez met with Ashley Sylve and explained the purpose of today's visit.

Throughout the course of this investigation, the Department reviewed facility files, conducted interviews, and inspected the facility. During the investigation, nine bathrooms were inspected, and eight out nine bathrooms were sanitary and clean. One bathroom was in the process of being cleaned. Furthermore, four residents reported their bathrooms are always cleaned and had no complaints. Furthermore, resident 1's (R1) January, February, and March 2023 Medication Administration Records (MAR) were reviewed. It was learned R1 had a history of refusing medication, which the facility documented the medication refusals on the MARs. As a result there is not enough evidence to prove that facility staff was not following physician's orders.

Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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-20230222092020

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: APPLE RIDGE ASSISTED LIVING	FACILITY NUMBER: 347003117
	VISIT DATE: 07/13/2023

NARRATIVE

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In addition, R1's January, February, and March MARs reported two medications were awaiting refill from the pharmacy. It was also learned R1 was on hospice, and hospice was responsible for refilling R1's medication. Additionally, Hospice was working with their assigned pharmacy. It was also, learned Hospice staff would review R1's medication supply, and order refills if needed. In addition, facility staff would also communicate to Hospice when R1 needed a medication refilled. Due to the above noted information, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, and therefore the allegations are unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC9099 (FAS) - (06/04)

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