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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347004960
Report Date: 06/29/2023
Date Signed: 06/29/2023 10:58:02 AM

Unsubstantiated


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
03/27/2023 and conducted by Evaluator Victoria Brown
COMPLAINT CONTROL NUMBER: 27-AS-20230327130639
FACILITY NAME:EASTERN MANORFACILITY NUMBER:
347004960
ADMINISTRATOR:APUYA, MARIAFACILITY TYPE:
740
ADDRESS:2629 EASTERN AVENUETELEPHONE:
(916) 972-9668
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:13CENSUS: 9DATE:
06/29/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Geronima BautistaTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff force fed resident in care
Staff does not provide proper medication assistance to resident in care
Staff did not provide repositioning assistance to resident in care
Staff did not provide proper night supervision to residents in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA Victoria Brown arrived unannounced on 6/29/23 at 9:30am to further investigate the above mentioned allegations. LPA met with Geronima Bautista and stated the purpose of the visit. LPA reviewed interviews, hospice records, and contacted Vitas during this visit. Regarding allegation, Staff force fed resident in care, Staff does not provide proper medication assistance to resident in care, Staff did not provide repositioning assistance to resident in care, Staff did not provide proper night supervision to residents in care, the investigation revealed that no preponderance of evidence was observed or obtained to substantiate the facility failed to uphold resident rights and provide appropriate care and supervision. Based on interviews and insufficient evidence allegation is deemed UNSUBSTANTIATED. A finding of 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. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was conducted, copy of report provided.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
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 1