347003994-7-23-2024-59-AS-MSEY-D7PSJS-20240731135538

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347003994
Report Date: 07/23/2024
Date Signed: 07/23/2024 01:56:54 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
07/20/2024 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20240720224011

FACILITY NAME:	AEGIS ASSISTED LIVING OF CARMICHAEL		FACILITY NUMBER:	347003994
ADMINISTRATOR:	TRACY LEHNER		FACILITY TYPE:	740
ADDRESS:	4050 WALNUT AVE		TELEPHONE:	(916) 972-1313
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	90	CENSUS: 71	DATE:	07/23/2024
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Tracy Lehner		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not prevent resident from eloping from the facility.

INVESTIGATION FINDINGS:

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LPA Parks arrived on Tuesday July 23, 2024 to open a complaint investigation regarding the above allegation.

LPA discussed the allegation with Administrator Tracy and Health Services Director Tayjahana. Through interviews, LPA learned that R1 moved out of the facility on 7/10/2024, into the care of their daughter. At the time of the incident where R1 was found, they were not a resident at this facility. During R1's stay at the facility, there were no instances of R1 eloping. LPA obtained a 30 day notice for R1 and documenation showing that R1 was discharged from care on 7/10/2024.

Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegation is found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. A copy of this report was left at the facility. Exit interview conducted. A copy of this report was emailed to the administrator.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

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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