347004963-7-6-2023-59-AS-KHOS-CTMRSU-20230711131720

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347004963
Report Date: 07/06/2023
Date Signed: 07/06/2023 03:14:24 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, 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
03/28/2023 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 59-AS-20230328155820

FACILITY NAME:	MILES MANOR		FACILITY NUMBER:	347004963
ADMINISTRATOR:	MILES, RACHEL		FACILITY TYPE:	740
ADDRESS:	4301 WATKINS DRIVE		TELEPHONE:	(916) 967-9049
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	15	CENSUS: 14	DATE:	07/06/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Kimberly Rosa, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Residents are chemically restrained with medication
-Facility staff not fingerprint-cleared
-Staff are using drugs while on duty
-Facility staff are abusing residents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Angela Hood and Michael Hood arrived at the care home today and met with the Administrator, Kim Rosa, to deliver findings into the allegations listed above.

During the course of the investigation, interviews were conducted, a medication count was conducted for residents (R1 & R3), and documentation pertinent to the investigation was obtained. LPA found no errors in Trazadone 100mg for both R1 and R3, which are prescribed as a sleep aid. LPA reviewed facility roster indicating that all staff working at the facility are criminal background check cleared. Interviews conducted with staff (S1 & S2) as well as R1 and resident (R2) indicated that they have never witnessed staff using drugs while on duty. Interviews with R1 and R2 indicated that they have never experienced abuse or witnessed staff abusing residents in care. Interviews with S1 and S2 indicated that they have not witnessed staff abusing residents.

Based on interviews conducted, documentation reviewed, and medication count, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies are being cited during this visit.

Exit interview conducted. A copy of the report was provided to the Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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 3