347004702-9-20-2022-27-AS-KHOS-CJGKDZ-20220921074933

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347004702
Report Date: 09/20/2022
Date Signed: 09/20/2022 08:41:30 AM

Unfounded

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
06/21/2022 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20220621111736

FACILITY NAME:	MEADOWS AT COUNTRY PLACE, THE		FACILITY NUMBER:	347004702
ADMINISTRATOR:	RANGI GINER		FACILITY TYPE:	740
ADDRESS:	10 COUNTRY PLACE		TELEPHONE:	(916) 706-3949
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95831
CAPACITY:	34	CENSUS: 23	DATE:	09/20/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Rangi Giner		TIME COMPLETED:	08:45 AM

ALLEGATION(S):

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Facility is not providing PPE to staff
Facility staff is not serving a good quality of food

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conclude a complaint investigation on 9/20/22 at 8:30am.

LPA met with Rangi Giner and stated the purpose of the visit. LPA observed that Licensee is on premises assisting residents along with staff during this visit.

Upon arrival during the visit on 6/23/22, LPA observed the residents to be finishing lunch. The meal consisted of mashed potatoes and gravy, stir fried vegetables, meatloaf, pudding, cole slaw, with choice of lemonade, orange juice, coffee, and hot/cold cocoa. LPA conducted interviews of staff #1 (S1-S2), Resident #1 (R1), and Licensee.

LPA requested and received a roster of residents and staff which included contact with information for staff.

Unfounded

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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-20220621111736

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: MEADOWS AT COUNTRY PLACE, THE	FACILITY NUMBER: 347004702
	VISIT DATE: 09/20/2022

NARRATIVE

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Regarding allegation, “Facility is not providing PPE to staff” S1-S3 stated, the Licensee provides the PPEs to staff, they are not required to purchase their own PPE/masks but they can buy their own if they wish to do so. S1 is the person who replenishes the PPEs to ensure the facility doesn’t run out. S2 and S3 stated that some staff like to purchase their own. There is PPEs locked in storage and some available to be used near the front door. R1, R3, and R4 stated staff wear their masks. On 6/23/22, an unannounced visit, LPA toured the facility and observed staff wearing masks and a stock of PPEs near the front door for staff use.

Regarding allegation, “Facility staff is not serving a good quality of food” R1, R3, and R4 stated to LPA the food is good. S1 stated diabetic type foods meaning sugar free are provided to residents who are diabetic, and the facility also provides foods specific to the resident’s culture when they want it. Residents are asked about their meals and preferences for example on how they wish their eggs to be cooked and if they want what’s on the menu for that day. S2 and S3 concurred.

The investigation revealed that there was insufficient evidence to substantiate the allegations.

Based on interviews, the preponderance of evidence standards has not been met.

“This agency has investigated the complaint alleging, the above-mentioned allegation(s). We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.”

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were cited during this visit. An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC9099 (FAS) - (06/04)

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