347005479-4-23-2024-59-AS-LMUZ-D4VUXV-20240502155856

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005479
Report Date: 04/23/2024
Date Signed: 04/23/2024 09:54:20 AM

Substantiated

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
03/21/2024 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20240321121527

FACILITY NAME:	RENAISSANCE SENIOR CARE		FACILITY NUMBER:	347005479
ADMINISTRATOR:	LILLI LAPADAT		FACILITY TYPE:	740
ADDRESS:	7316 MAIN AVENUE		TELEPHONE:	(916) 932-4303
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	6	CENSUS: 4	DATE:	04/23/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator, Lilli Lapadat		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility is not meeting reporting requirements.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 04/23/24 to deliver complaint findings for the above allegation. LPA met with administrator, Lilli Lapadat, and explained the purpose of the visit.

The department conducted a record review and interviews with staff to investigate this complaint allegation. Based on the records reviewed, it has been determined that the facility did not report incidents for resident R1, regarding R1s hospital/ER visit for 02/05/24, 02/06/24 and 02/09/24. Through records review and staff interviews, it is determined that although facility may have generated SIR (LIC624), the facility failed to submit SIR (LIC624) to the Department as required by regulations.Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page.

Exit interview conducted, appeal rights and copy of the report was provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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 4

Control Number 59-AS-20240321121527

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: RENAISSANCE SENIOR CARE	FACILITY NUMBER: 347005479
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/23/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/05/2024 Section Cited CCR 87211(a)(1)(D)	1 2 3 4 5 6 7	87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department [...]: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident [...] (D) Any incident which threatens the welfare, safety or health of any resident [...]..This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee to review section 87211 Reporting Requirements and send a letter of understanding to Community Care Licensing. Additionally, licensee to ensure incident reports are filled out and faxed to CCL with confirmation. All POC documents are due by 05/05/24.
	8 9 10 11 12 13 14	Based on interviews and records review, the facility did not comply with the section cited above by not reporting incidents which threatened the welfare of R1. This poses a potential health, safety, and/or personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
03/21/2024 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20240321121527

FACILITY NAME:	RENAISSANCE SENIOR CARE		FACILITY NUMBER:	347005479
ADMINISTRATOR:	LILLI LAPADAT		FACILITY TYPE:	740
ADDRESS:	7316 MAIN AVENUE		TELEPHONE:	(916) 932-4303
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	6	CENSUS: 4	DATE:	04/23/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator, Lilli Lapadat		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff did not ensure that resident's dietary needs were met.
Staff yelled at resident.

INVESTIGATION FINDINGS:

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On 04/23/24, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with administrator,Lilli Lapadat and explained the purpose of the visit.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20240321121527

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: RENAISSANCE SENIOR CARE	FACILITY NUMBER: 347005479
	VISIT DATE: 04/23/2024

NARRATIVE

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**Report continued from 9099-A......

Allegation- Staff did not ensure that resident's dietary needs were met.- Unsubstantiated.

LPA interviewed (4) four residents regarding the food that is offered and facility’s dietary services. Residents indicated they are satisfied with the variety of food they are served. During interviews, residents indicated they have enough food during each meal on a daily basis. During interviews with (4) four staff, staff indicated that staff assist residents with their dietary needs per their service and care plan. LPA reviewed resident’s (R1) LIC602 and did not observe any dietary restrictions. Furthermore, it was alleged that staff were not assisting R1 with meal service. Based on records reviewed and interviews conducted, R1 did not need any assistance with eating and did not require any staff assistance with meals. Due to the information gathered, LPA finds allegation to be Unsubstantiated.

Allegation- Staff yelled at resident.-Unsubstantiated

During (4) four staff interviews, staff indicated that they have never witnessed any staff yelling at residents. During interviews with (4) four residents, it was revealed that staff do not yell at them. Residents’ interviews indicated that staff were professional with their job and residents were treated with respect and dignity at facility. Staff stated that some of the residents are hard of hearing, so staff have to speak loudly to them. Based on LPA interviews, it was determined that staff did not yell at a resident therefore the allegation is Unsubstantiated.

Based on this information, these allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated.

Exit interview with Administrator. Copy of the report provided to facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC9099 (FAS) - (06/04)

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