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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005251
Report Date: 07/11/2023
Date Signed: 07/11/2023 12:52:06 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
05/25/2023 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20230525110934
FACILITY NAME:ATRIA CARMICHAEL OAKSFACILITY NUMBER:
347005251
ADMINISTRATOR:HAGEN, KIMBERLYFACILITY TYPE:
740
ADDRESS:8350 FAIR OAKS BLVDTELEPHONE:
(916) 944-2323
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:95CENSUS: 69DATE:
07/11/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Christina OrtizTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not safeguard resident's belongings.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/11/23, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Christina Ortiz.

LPA conducted records review and interviews.
LPA is unable to find and or meet the preponderance, per policy.
The investigation found that R1 has reported items missing, witnesses nor suspects were identified. R1 denies that the reported missing items have been recovered. During the time that items were reported to have been missing, facility door records showed the resident's door to have been unlocked when R1 was not present.

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is 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.
Exit interview with Christina Ortiz. Copy of this report provided
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
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 2
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
05/25/2023 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20230525110934

FACILITY NAME:ATRIA CARMICHAEL OAKSFACILITY NUMBER:
347005251
ADMINISTRATOR:HAGEN, KIMBERLYFACILITY TYPE:
740
ADDRESS:8350 FAIR OAKS BLVDTELEPHONE:
(916) 944-2323
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:95CENSUS: DATE:
07/11/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Chistina OrtizTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure that a written personal property inventory was established upon resident's admission.

Staff did not ensure that resident was able to report a theft to authorities.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/11/23, Licensing Program Analyst (LPA) Kevin Mknelly LPA Mknelly arrived and met with Christina Ortiz to deliver investigation findings.

LPA reviewed staff records, facility records, and conducted interviews.
LPA finds that facility met Tittle 22 requirements.
Records and interviews found that R1 declined to declare personal items upon admission nor at any later point while a resident.
Records and statements also found that a police report was submitted after facility staff interviewed R1 and assisted in a search of their room.

This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.
Exit interview conducted and report provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2