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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005361
Report Date: 05/16/2025
Date Signed: 05/16/2025 12:43:55 PM

Substantiated


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
05/08/2025 and conducted by Evaluator Kimberly Viarella
COMPLAINT CONTROL NUMBER: 27-AS-20250508151929
FACILITY NAME:SUMMERSET ASSISTED LIVINGFACILITY NUMBER:
347005361
ADMINISTRATOR:DANIELLE BARRYFACILITY TYPE:
740
ADDRESS:2341 VEHICLE DRTELEPHONE:
(916) 330-1300
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:135CENSUS: 87DATE:
05/16/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Danielle BarryTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility is not allowing residents to get mail.
INVESTIGATION FINDINGS:
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On 05/16/25 Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to open a complaint into the above allegation. 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.

LPA requested the following documents:
LIC 602 for Resident (R1)
Copy of Personal Rights provided to residents
Copy of conservatorship of R1
Emergency Contact/ID information

As part of this investigation, LPA reviewed the above documents and conducted interviews. LPA found based on a review of documents that the resident was conserved and living in memory care. Based on
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
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-20250508151929
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: 05/16/2025
NARRATIVE
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Based on conversations with 5 staff members (S1-S5), there was a process in place for mail for the memory care residents as they did not have mailboxes on the main level.

This LPA was told that their mail was dropped off at the reception desk where it was sorted and then the medication technicians (MedTechs) on the send floor were notified to pick it up. They would then deliver the mail to the individual residents in the memory care community. If the resident had a conservator, there was a special area in the locked medication room where this mail was labeled and stored. The MedTechs would then call the conservator to alert them that mail had arrived for the resident and then the conservator would be asked to come and pick it up. If there was no response to their call or messages, the MedTech would text the conservator, and then document with post it notes the dates when their contact attempts were made. LPA asked the Director of Care what process was in place if they could not reach a conservator in a timely manner. LPA was told that there was a number they could call that for the Conservator of the Day that would assist them.

In this particular case, this LPA learned through personal observations, that residents' mail, not just the items that were the responsibility of the conservator (i.e. medical and/or financial) were stored in the medication room. LPA observed personal letters and cards from April 2025, in a sorting container on top of a cabinet. The sorter was labeled, "Residents Mail for POA."

Through interviews, this LPA learned that staff (S3) had withheld all mail because they thought that legally they had to give it directly to the conservator. LPA explained to S3 that was a violation of the resident's personal rights and that their personal mail should have been delivered to them directly.

The allegation: Facility not allowing residents to get mail, was SUBSTANTIATED and this deficiency was cited on the LIC 9099D page. According to the California Code of Regulations, Title 22, no other deficiencies were observed or cited during today's visit.

ED stated that a training has been scheduled for the medication technicians in memory care next week on what mail to deliver, and what to hold for a residents' responsible parties.

A copy of this report was provided along with APPEAL RIGHTS and an exit interview was conducted.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 27-AS-20250508151929
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2025
Section Cited
CCR
87468.2
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Additional Personal Rights of Residents in Privately Operated Facilities
(a) In addition to 87468.1, ...the elderly shall have all of the following personal rights:(1) To have ...in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations...
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ED stated that a training will be held with all medication technicians by 5/30/25 regarding what mail should be delivered and what shoudl be held for responsible parties. ED will submit a outline of training along with signature sheets for participants to CCLASCPSacrementoRO@dss.ca.gov
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The licensee did not ensure that the above regulation was met when: Based on personal observations and interviews, mail for residents in memory care was being held until conservators could pick it up. This posed a potential threat to the health safety and personal rights of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3