<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347003994
Report Date: 07/06/2020
Date Signed: 07/06/2020 11:16:55 AM



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
06/12/2020 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20200612114823
FACILITY NAME:AEGIS ASSISTED LIVING OF CARMICHAELFACILITY NUMBER:
347003994
ADMINISTRATOR:CHUCK SCHURINGAFACILITY TYPE:
740
ADDRESS:4050 WALNUT AVETELEPHONE:
(916) 972-1313
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:90CENSUS: 70DATE:
07/06/2020
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Chuck Schuringa, General Manager/AdministratorTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff failed to provide authorized representative copy of resident's records within required time frame.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sabrina Calzada contacted the facility via telephone on 7/6/2020 to deliver findings to a complaint the department received on 6/10/2020 for the above allegation. Findings are delivered via telephone due to COVID-19 and pre-cautionary measures. LPA discussed the purpose of the call and the elements of the allegation with Chuck Schuringa, Administrator.

The results of the investigation are as follows:

Records request letter dated 6/4/2020 requests that the facility contact the requestor "within two working days to arrange the photocopying of the entirety of the resident records...." The facility Administrator confirmed that the request for records was received on Saturday, 6/6/2020, and was forwarded by e-mail to the facility's home office upon receipt. E-mail documentation shows that the facility home office confirmed receipt of the records request with the requestor on Monday, 6/8/2020, and asked if it was acceptable that records be provided via e-mail since third parties were not allowed in the community to obtain photocopies (due to Covid-19 pre-cautionary measures). E-mail documentation dated 6/9/2020 notes that the requestor confirmed that e-mail was an acceptable way to receive the requested documents and provided an email address of where to send them. Additional e-mail exchanges, dated 6/11/2020, note that the facility indicated there were too many documents to send by e-mail, and it was agreed that the records would be sent by overnight mail, on 6/12/2020.
*cont on 9099C..
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) -26-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2020
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 2
Control Number 27-AS-20200612114823
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: AEGIS ASSISTED LIVING OF CARMICHAEL
FACILITY NUMBER: 347003994
VISIT DATE: 07/06/2020
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
Shipping documentation shows that the records were shipped to the requestor on Friday, 6/12/2020 and two delivery attempts were made before documents were delivered on Monday, 6/15/2020.

The records request letter, dated 6/4/2020, states that if the requestor is not contacted "within two working days to schedule the inspection", a formal complaint will be filed with the Department of Social Services. E-mail documentation shows that the records request was received by the home office on Monday, 6/8/2020, and the requestor was contacted by e-mail on the same day, explaining that copies of the records were not able to be obtained in person and would need to be mailed. An e-mail response was sent by the requestor, on 6/9/2020, that it would be acceptable for the facility to e-mail the records. The facility did not fail to contact the requestor within two working days of receipt of the records request.

The records request letter also references California Health and Safety Code ยง1569.269 (a)(21) which states (a)"Residents of residential care facilities for the elderly shall have all of the following rights: (21)To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided, not to exceed two business days, at a cost not to exceed the community standard for photocopies." Prior resident (R1) was no longer a resident of the facility when the records request was made on 6/4/2020. The facility did not fail to adhere to this code which pertains to current residents.

Based on information obtained during the investigation, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

There are no deficiencies being issued.

An exit interview was conducted with Chuck Schuringa, Administrator, via telephone and a copy of this report will be provided to the facility via email. Administrator agrees to immediately return a signed copy to CCL and retain a copy for facility records.


SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) -26-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2