347005464-7-1-2024-27-AS-SRIN-D7ATCC-20240718143630

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005464
Report Date: 07/01/2024
Date Signed: 07/01/2024 02:10:48 PM

Unsubstantiated

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
03/27/2024 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240327145359

FACILITY NAME:	CARLTON PLAZA OF ELK GROVE		FACILITY NUMBER:	347005464
ADMINISTRATOR:	JENNELL REVERA		FACILITY TYPE:	740
ADDRESS:	6915 ELK GROVE BLVD.		TELEPHONE:	(916) 714-2404
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	180	CENSUS: 142	DATE:	07/01/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Jennell Revera		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff did not provide adequate food service
Staff did not meet resident's toileting needs
Staff did not meet resident's showering needs
Staff did not treat resident with respect
Staff overcharged resident
Staff mismanaged resident's medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Jennell Revera and explained the purpose of the visit.

This investigation consisted of interviews, observation and record review. LPA Moleski interviewed Revera, 10 staff members (S1-S10), four residents (R1-R4), and a resident’s responsible party (R1’s RP).

In an interview, R1 said that R1 liked the food at the facility, and always gets enough to eat. R1 said they had not missed any meals at the facility. R1 said that they preferred to have meals delivered to their room, rather than going downstairs to eat. R1 said staff assisted them with showers, and said they received showers about once every other day. R1 said they received enough showers, and in fact would prefer fewer showers, as R1 is often tired in the mornings. [continued on 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

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-20240327145359

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: CARLTON PLAZA OF ELK GROVE	FACILITY NUMBER: 347005464
	VISIT DATE: 07/01/2024

NARRATIVE

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R1 said that staff assist them with toileting, and will clean them up if they can’t make it to the toilet. R1 said staff do a good job, but sometimes R1 has to wait up to an hour or two for assistance. R1 said that the staff are kind to R1. R1 reported no issues with medications, and said that staff give PRN medications when R1 asks for them.

LPA Moleski reviewed R1’s file. R1 is scheduled to receive showers twice a week. Interviews with staff indicate that R1 often refused showers and other care. None of the staff members interviewed reported concerns over R1’s hygiene, or over the frequency of R1’s showers. LPA Moleski reviewed one months’ worth care notes for R1 and observed R1 received six showers between 3/9/24 and 4/8/24. A refusal of a shower is documented in the notes. LPA Moleski reviewed R1’s MARs dating from August 2023 to May 2024. LPA Moleski observed no indication that R1’s medications were mismanaged. R1 appeared to have received all prescribed medications as needed. LPA Moleski did not observe any indication that R1 had received any laxatives during night shifts, as alleged. LPA Moleski observed one dose of PRN laxative given on the afternoon of 9/25/23, and a note on the MAR indicates that it was given at the request of R1’s RP. None of the staff members interviewed knew of any incident wherein PRN laxatives were given without authorization. LPA Moleski reviewed R1’s billing information, invoices, meal tickets, and tallies of R1’s room service deliveries. LPA Moleski reviewed several weeks’ worth of meal tickets and observed that R1 was regularly receiving meals. LPA Moleski did not observe any indication that R1 was overcharged for room service. LPA Moleski observed that the documented number of room service deliveries matched the amount charged, per the rate of $15 per delivery after 6 deliveries per month. Staff interviews indicate that R1 usually did not want to come down for meals and preferred room service. None of the staff interviewed had observed any other staff members acting rudely or disrespectfully to R1.

LPA Moleski interviewed three residents (R2-R4) who liked to eat meals with R1 when R1 was able to come down into the dining room to eat. None of the residents interviewed had observed any staff members acting rudely or disrespectfully to R1.

[continued on 9099-C]

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20240327145359

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: CARLTON PLAZA OF ELK GROVE	FACILITY NUMBER: 347005464
	VISIT DATE: 07/01/2024

NARRATIVE

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LPA Moleski reviewed 30 days’ worth of call button response times for R1 dating from 3/9/24 to 4/8/24. The average of response times is approximately nine minutes. None of the response times range over an hour. None of the staff members interviewed were aware of any situation wherein R1 needed to wait for toileting assistance for over an hour.

The department has determined the following as it relates to the allegations that staff did not provide adequate food service, that staff did not meet a resident’s toileting needs, that staff did not meet a resident’s showering needs, that staff did not treat a resident with respect, that staff overcharged a resident, and that staff mismanaged a resident’s medication:

Based on interviews, observation and record review, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies were cited regarding the above allegations. An exit interview was held and a copy of this report was left with Revera.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

LIC9099 (FAS) - (06/04)

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