347005251-9-7-2023-59-AS-MSEY-CVGS4A-20230908133224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005251
Report Date: 09/07/2023
Date Signed: 09/07/2023 02:18:59 PM

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
09/01/2023 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 59-AS-20230901100431

FACILITY NAME:	ATRIA CARMICHAEL OAKS		FACILITY NUMBER:	347005251
ADMINISTRATOR:	DAVIS, KAYLA		FACILITY TYPE:	740
ADDRESS:	8350 FAIR OAKS BLVD		TELEPHONE:	(916) 944-2323
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	95	CENSUS: 66	DATE:	09/07/2023
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Kayla Davis, Executive Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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-Staff did not disclose previous complaints filed
-Staff financially abused a resident
-Staff mishandled a resident's medical form

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Executive Director (ED), Kayla Davis, to open complaint and deliver findings into the complaint allegations listed above.

During today's visit, LPA was informed by the ED that resident (R1) has never resided at the facility. ED contacted the ED, Kimberly Hagen, at the Atria El Camino Gardens location. LPA was informed that R1 moved out of the El Camino Gardens location on 8/11/2023.

Allegation: Staff did not disclose previous complaints filed.
The complaint is regarding not being notified of complaints filed at the Atria locations in Walnut Creek and San Mateo. The facility is only required to disclose complaints filed at their location.

*********************************************Continued on LIC9099-C****************************************************

Unfounded

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: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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 59-AS-20230901100431

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: ATRIA CARMICHAEL OAKS	FACILITY NUMBER: 347005251
	VISIT DATE: 09/07/2023

NARRATIVE

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Allegation: Staff financially abused a resident.
The allegation regarding financial abuse was investigated at the El Camino Gardens location. The findings were delivered on 5/4/2023 and were Unsubstantiated. The Department conducted records review and interviews. On 3/17/2023, the ED indicated that money removed from R1's account was from an auto payment that R1 had signed up for during admission to the facility. Interview with R1 indicated that they had requested a stop to the auto payments, however, facility continued with auto payments.

The complaint is also regarding overcharging, which was investigated at the El Camino Gardens location. The findings were delivered on 3/24/2023 and were Unsubstantiated. The Department conducted a records review of R1's admission agreement and invoices itemizing charges from October 2022-March 2023. R1's admission agreement signed 10/27/2022 states "If you become a safety risk to yourself or to others during your residency, we have the right in our sole determination to obtain, at your expense, private duty personnel to provide supervision or assistance until you move from the Community or your safety is no longer at risk." According to interview with ED, the facility began providing R1 with additional supervision ensuring R1's safety after a suicide attempt that occurred on 1/1/2023. R1 was charged due to the change in condition.

Allegation: Staff mishandled a resident's medical form.
The allegation regarding mishandled medical form was investigated at the El Camino Gardens locations. The findings were delivered on 5/4/2023 and were Unsubstantiated. The Department conducted record review and interviews to investigate this allegation. Interview with R1 indicated that they believe the facility intentionally altered their Physician Report LIC602A in order to increase R1's rent. Interview with ED conducted on 3/17/2023 indicated that a new LIC602A was faxed to the facility by R1's primary care physician (PCP) after ED expressed concerns to R1's PCP regarding R1's medications. Record review indicated that R1 signed an Authorization to Release Health Information form which permits the facility to contact R1's PCP for medical purposes. Records review also indicated that R1 has had five (5) LIC602As since October 2022.

Due to the information provided that R1 has never resided at the Carmichael Oaks location and that the allegations have already been investigated at the El Camino Gardens location, the above allegations are found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

No deficiencies are being cited. Exit interview conducted and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC9099 (FAS) - (06/04)

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