347005512-7-13-2022-27-AS-KHOS-CGPS2V-20220726133011

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005512
Report Date: 07/13/2022
Date Signed: 07/13/2022 02:48:10 PM

Unsubstantiated

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
07/11/2022 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20220711163102

FACILITY NAME:	ELK GROVE PARK ASST. LVG AND MEMORY CARE COMMUNITY		FACILITY NUMBER:	347005512
ADMINISTRATOR:	JAMES HALL		FACILITY TYPE:	740
ADDRESS:	6727 LAGUNA PARK DR		TELEPHONE:	(916) 683-1881
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	108	CENSUS: 54	DATE:	07/13/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Susie Sarria, BOM		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility is not following COVID protocols.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct an investigation of the allegation mentioned above on 7/13/2022 at 2pm. LPA met with Susie Sarria, Business Office Manager and stated the purpose of the visit. LPA toured the physical plant which included all four cottages and Community Center. LPA observed that the covid related cases have all cleared except 1 resident. In addition, there is 3 staff that is still not present in the facility. LPA observed there is a sufficienat amount of PPEs during this visit. LPA observed all staff and visitors utilizing masks during this visit and there is signage posted upon entry of every building.
Based on interviews, observation and lack of evidence the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be UNSUBSTANTIATED.
A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was conducted, and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion: 30

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022

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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