347004466-4-23-2024-59-AS-LMUZ-D4VUYB-20240502155940

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347004466
Report Date: 04/23/2024
Date Signed: 04/23/2024 11:03:59 AM

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
03/19/2024 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20240319092550

FACILITY NAME:	TRAJAN VILLA CARE HOME		FACILITY NUMBER:	347004466
ADMINISTRATOR:	FLORICA SOTEA		FACILITY TYPE:	740
ADDRESS:	6201 TRAJAN DRIVE		TELEPHONE:	(916) 358-6907
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	6	CENSUS: 3	DATE:	04/23/2024
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Co-administrator- Eugen Georgescu		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Facility staff did not safeguard resident's belongings.

INVESTIGATION FINDINGS:

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On 04/23/24, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Co-administrator- Eugen Georgescu.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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 4

Control Number 59-AS-20240319092550

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TRAJAN VILLA CARE HOME	FACILITY NUMBER: 347004466
	VISIT DATE: 04/23/2024

NARRATIVE

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***Report continued from 9099......

Allegation- Facility staff did not safeguard resident's belongings ---Unfounded

The department conducted (2) two staff (3) three residents’ interviews, facility’s observations, and record review to investigate this allegation. From the records review, it has been revealed that the facility has a record of some of R1’s personal belongings which is documented and located in R1’s facility file. Staff interviewed (S1) indicated that facility was trying their best to safeguard residents (R1) belongings however, R1 has resided at the facility since 03/01/23, some of R1’s personal belongings were brought in and been taken away by R1 and their family. R1 relocated to another facility on 02/29/24. Staff indicated it was difficult to locate all of R1’s belongings as there was items brought in after being admitted to the facility on 03/01/23. R1 and R1’s family did not always notify the facility items were being brought in therefore missing items identified were not listed on R1’s facility Inventory Sheet. Based on Health and Safety code §1569.153 (d), in part, “Subsequent items brought into or removed from the facility shall be added to or deleted from the personal property inventory by the facility at the written request of the resident, the resident's family, a responsible party, or a person acting on behalf of a resident. The facility shall not be liable for items which have not been requested to be included in the inventory or for items which have been deleted from the inventory”. During the department visit, facility was able to find most of the missing items for R1 and R1 was contacted by LPA so R1 could make arrangements to pick up items from facility. Based on all this information, this allegation is found to be Unfounded.

Based on the investigation, the preponderance of evidence standards has not been met. Therefore, the above all allegations is found to be UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

Exit meeting conducted. A copy of this report has been provided to facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
03/19/2024 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20240319092550

FACILITY NAME:	TRAJAN VILLA CARE HOME		FACILITY NUMBER:	347004466
ADMINISTRATOR:	FLORICA SOTEA		FACILITY TYPE:	740
ADDRESS:	6201 TRAJAN DRIVE		TELEPHONE:	(916) 358-6907
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	6	CENSUS: 3	DATE:	04/23/2024
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Co-administrator- Eugen Georgescu		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Facility staff did not dispense medications as prescribed.
Facility staff yelled at resident.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20240319092550

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TRAJAN VILLA CARE HOME	FACILITY NUMBER: 347004466
	VISIT DATE: 04/23/2024

NARRATIVE

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***Report continued from 9099-A......

Allegation- Facility staff did not dispense medications as prescribed---Unsubstantiated

Based on the information provided, the investigation conducted by the department involved facility observations, record review, and interviews with (2) two staff and (3) three residents. During interviews, it was revealed that the facility dispensed 3 residents' medications on time and administered medication as ordered. 2 out of 3 residents’ interviews indicated that staff were assisting them with their medications without any issues. Furthermore, a review of R1’s medication logs for January and February 2024 indicated the facility maintained proper logs for all centrally stored medications based on Title 22 Regulations. Based on these findings, this allegation is considered -Unsubstantiated

Allegation- Facility staff yelled at resident.---Unsubstantiated

Based on the interviews conducted with the resident’s R2 and R3 and staff member’s S1 and S2, it has been determined that there is no evidence of staff yelling at residents. S1 mentioned that staff may speak loudly to residents who are hard of hearing in order to effectively communicate with them. R2 and R3 revealed that the staff provide care and assistance in a professional manner. Residents indicated they have not experienced any disrespect or misconduct or being yelled at by any staff member at the facility. Based on these findings, there is insufficient evidence of staff being disrespectful or engaging in any misconduct towards the residents therefore, this allegation is Unsubstantiated.

Based on this information, these allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated.

Exit interview with Co-Administrator. Copy of the report provided to facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC9099 (FAS) - (06/04)

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