347003117-8-3-2023-27-AS-CACL-CUKLV2-20230810090451

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347003117
Report Date: 08/03/2023
Date Signed: 08/03/2023 11:49:23 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
03/20/2023 and conducted by Evaluator Avelina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230320111718

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: 63	DATE:	08/03/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Ashley Sylve		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Residents are falling due to a lack of supervision.
Residents are left in soiled briefs due to lack of staffing.
Residents are not getting toileted due to lack of staffing.
Residents are not getting showers timely due to a lack of staffing.

INVESTIGATION FINDINGS:

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On 08-03-2023 at 8:30 AM, Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced facility visit to open a complaint investigation. LPA met with Ashley Sylve and explained the purpose of today's visit.

Throughout the course of the investigation, LPA Martinez reviewed facility documents, inspected the facility, and conducted interviews. LPA Martinez reviewed fall documentation. It was noted there were seven falls between July 1, 2023 and August 2, 2023. The fall incidents were due to self transfers, falling out of bed, and self transfers with physical behaviors. Four of the falls are associated to resident 1 (R1). It was learned R1 is on a fall risk care plan that includes fall mats. The facility has also conducted care plan meetings to address the falls, as R1 is not always compliant with the implemented fall risk care plan.

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: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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-20230320111718

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: 08/03/2023

NARRATIVE

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LPA Martinez interviewed five residents who require incontinent care. The five residents reported they are satisfied with the incontinent care they are receiving from the facility. Moreover, five out five residents reported their brief is changed timely, and do not have issues with being left in soiled briefs or toileting.

LPA Martinez observed staff assisting residents with showers during today's visit. In addition, eleven residents were scheduled to shower on August 3, 2023 at the AM shift. It was learned three residents refused showers, and eight residents received showers during the AM shift. Furthermore, LPA Martinez interviewed five residents, and the five residents reported they did not have any concerns in regards to showering and the care that is being provided.

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.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC9099 (FAS) - (06/04)

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