347005361-1-10-2025-27-AS-KHOS-DJFJZ6-20250710072901

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005361
Report Date: 01/10/2025
Date Signed: 01/10/2025 03:20:42 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
01/03/2025 and conducted by Evaluator Kimberly Viarella

COMPLAINT CONTROL NUMBER: 27-AS-20250103102458

FACILITY NAME:	SUMMERSET ASSISTED LIVING		FACILITY NUMBER:	347005361
ADMINISTRATOR:	DANIELLE BARRY		FACILITY TYPE:	740
ADDRESS:	2341 VEHICLE DR		TELEPHONE:	(916) 330-1300
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95670
CAPACITY:	135	CENSUS: 95	DATE:	01/10/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Danielle Barry		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff are not dispensing medications as prescribed
Facility staff are falsifying resident records

INVESTIGATION FINDINGS:

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On 01/10/25 Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to open a complaint into the above allegations. LPA identified herself upon arrival, stated the purpose of the visit, and asked to speak to the Designated Facility Administrator/Executive Director (ED) Danielle Barry. LPA met with the ED and a brief interview followed.

This LPA requested a copy of the schedule for carestaff and med techs along with contact information as well as a copy of the resident roster.

The LPA then toured the facility and observed 3 residents sitting in the conversation area of the lobby chatting, 2 kitchen staff cleaning the dining room while 3 residents finished their meals, an activities staff member packing up holiday decorations, and a housekeeping servstaff member servicing resident rooms. In memory care, this LPA observed 7 residents sitting in the common area watching TV and being supervised by 1 caregiver. LPA observed another caregiver assisting a resident in their room and a 3rd caregiver was on

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

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

Control Number 27-AS-20250103102458

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUMMERSET ASSISTED LIVING	FACILITY NUMBER: 347005361
	VISIT DATE: 01/10/2025

NARRATIVE

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break. LPA spoke with the Director of Memory Care who assisted auditing the medication cart. LPA observed as a sample of 6 residents' medications were counted to ensure that all were accounted for and logged properly.

As part of this investigation, this LPA conducted interviews with 4 carestaff: S1 - S4. Each stated the med techs administered medications properly in a timely fashion. S4 stated that, "the med techs are always responsive. Our residents can't always speak up for themselves to tell us they are in pain so sometimes they act out and whether it is because they are in pain, or are agitated, the med techs always come right away."

This LPA also reviewed the Electronic Medication Record (EMAR) for the month of December for 6 residents in memory care. The reporting party alleged that med techs were inputting that medications were being given that were not. Through the medication cart audit and review of the EMAR, this LPA found no evidence the EMAR being falsified. All were in compliance at the time of this inspection.

Based on interviews with staff, a record review of the EMAR and Controlled Substance Log, as well as the audit of the medication cart, a preponderance for the standard of evidence was not met and the department found the allegations:

Facility staff are not dispensing medications as prescribed,
Facility staff are falsifying resident records,

UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened or is without a reasonable basis.

While reviewing the EMAR, this LPA observed a statement to describe why a resident did not receive their medication, "Physically unable to take." Each occurrence was investigated. Residents were not administered medications if they had loose stools and the medication would worsen conditions. Medications were not administered it the resident was out of the facility. A medication was not administered due to a resident being unable to swallow. This notation was also used if the facility was waiting for a script to be refilled. This LPA provided technical assistance in this area and the ED has stated that they will be putting a new process in place to address this issue and new terminology and/or additional notes would be included in the future.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20250103102458

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUMMERSET ASSISTED LIVING	FACILITY NUMBER: 347005361
	VISIT DATE: 01/10/2025

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	According to the California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit. A copy of this report was provided. Exit interview.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

LIC9099 (FAS) - (06/04)

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