347005361-3-28-2022-27-AS-KHOS-CD9HGY-20220407061155

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005361
Report Date: 03/28/2022
Date Signed: 03/28/2022 04:08:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/09/2021 and conducted by Evaluator Kevin Gould

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20211209123723

FACILITY NAME:	SUMMERSET ASSISTED LIVING		FACILITY NUMBER:	347005361
ADMINISTRATOR:	BEASLEY, CARLIE		FACILITY TYPE:	740
ADDRESS:	2341 VEHICLE DR		TELEPHONE:	(916) 330-1300
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95670
CAPACITY:	135	CENSUS: 115	DATE:	03/28/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Elisa weathers, Assistant Executive Director		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Neglect/Lack of Supervision:
1) Facility does not have sufficient staff to meet the residents' needs.
2) Facility staff did not provide a resident appropriate care and supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to Summerset Assisted Living (RCFE) on 3/28/22 at 9:30am to continue the investigation of the above allegations and to deliver the findings. LPA met with Assistand Executive Director and together discussed the investigation details.

Based on the interviews, observations and documentation obtained during the investigation process, the allegations cannot be substantiated. LPA Gould conducted a walk-through and shadowing of staff in the memory care unit. LPA observed two med-techs and four caregiver staff on duty during todays inspection. LPA shadowed morning and afternoon med pass and shadowed three caregivers though their rounds at the facility. LPA Gould conducted five staff interviews during today's inspection while shadowing staff. Based on the interviews and observations by LPA, LPA did not observe any needs of residents not being met by the facility staff. Staff answered all LPA questions with confidence and accuracy. All staff interviewed were able to identify showering schedules for residents and residents appeared clean and well groomed. Staff were also knowledgeable regarding specific needs of residents in care including assistance with activities of daily living such as feeding, incontinence care, showering and grooming. Report Continued on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022

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 27-AS-20211209123723

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SUMMERSET ASSISTED LIVING	FACILITY NUMBER: 347005361
	VISIT DATE: 03/28/2022

NARRATIVE

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LPA attempted to interview three residents but all were determined to be unreliable narrators as they were all exhibiting characteristics of dementia or could not answer LPAs questions.

Regarding providing resident with appropriate care and supervision. LPA observed an adequate number of staff who frequently provided redirection to residents to ensure the resident's health and safety. LPA did not observe residents in the elevators attempting to leave the facility. LPA observed there are three elevator entrances on the 2nd floor memory care unit. All elevators require a sequence of buttons to ensure the elevator will go to the second floor. To leave the second floor, a staff member will enter a password and observe guests getting into the elevator and ensuring doors are closed before returning to regular duties to ensure no residents leave the memory care unit unsupervised.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Neglect/Lack of Supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies noted or cited per California Code Regulation, TITLE 22.

Exit interview was conducted with the facility assistant executive director. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022

LIC9099 (FAS) - (06/04)

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