347003994-4-27-2023-25-AS-MSEY-CREMZV-20230501100343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347003994
Report Date: 04/27/2023
Date Signed: 04/27/2023 02:17:02 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
10/24/2022 and conducted by Evaluator Kevin Mknelly

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20221024145711

FACILITY NAME:	AEGIS ASSISTED LIVING OF CARMICHAEL		FACILITY NUMBER:	347003994
ADMINISTRATOR:	BILL PHELPS		FACILITY TYPE:	740
ADDRESS:	4050 WALNUT AVE		TELEPHONE:	(916) 972-1313
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	90	CENSUS:	DATE:	04/27/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Donald Stamets		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff did not prevent a resident from harassing another resident while in care

Resident's behavior poses as a risk to other residents while in care

Staff make inappropriate comments towards the residents

INVESTIGATION FINDINGS:

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On 4/27/23, Licensing Program Analyst (LPA) Kevin Mknelly spoke to Donald Stamets. The reason for the visit was to deliver findings for the allegation sited above. Upon entering the facility, analyst completed electronic screening and sign in. Analyst followed facility's policy and wore a surgical mask.

LPA conducted interviews with the Director. Director provided email copies regarding concerns raised regarding R1 and R2 interactions. LPA interviewed one resident.

While conducting this investigation, LPA reviewed resident records and conducted extensive interviews.
LPA finds that the allegation cited above are Unsubstantiated.

Interviews of residents and staff regarding staff not preventing a resident (R2) from harassing another resident (R1)while in care and resident's (R1) behavior poses as a risk to other residents while in care, did not support the allegations.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

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 25-AS-20221024145711

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: AEGIS ASSISTED LIVING OF CARMICHAEL	FACILITY NUMBER: 347003994
	VISIT DATE: 04/27/2023

NARRATIVE

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The allegations of R1's concerns regarding the behavior of R2 were documented as having been brought to the facility's attention in December 2021. Room changes were explored for both R1 and R2. Escort services were discussed for R1 when they moved throughout the community. Interviews of facility staff found the facility staff believed they provided escort for R1 when requested and that R1 would not request escorts before moving about in the community. Reporting party denies that escort services were provided as agreed.

Records review and interviews did not uncover any other reports of R2 behavior with other residents.

Regarding staff making inappropriate comments toward residents was also not supported by interviews or records. Given the time between the alleged incidents and the investigation made many of the staff or residents present in December 2021 no longer available during this investigation

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is 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 violation occurred.

Exit interview with administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC9099 (FAS) - (06/04)

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