347005512-10-15-2021-27-AS-SRIN-C7WV8J-20211018161245

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005512
Report Date: 08/10/2021
Date Signed: 10/15/2021 02:41:53 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
07/30/2021 and conducted by Evaluator Tirzah Hubbard

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20210730151636

FACILITY NAME:	ELK GROVE PARK ASST. LVG AND MEMORY CARE COMMUNITY		FACILITY NUMBER:	347005512
ADMINISTRATOR:	JERICA HOWARD		FACILITY TYPE:	740
ADDRESS:	6727 LAGUNA PARK DR		TELEPHONE:	(916) 683-1881
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	108; 108	CENSUS: 108	DATE:	08/10/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Executive Director Carie Baker		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Management did not notify the resident representative about the change in rent.

Mangement is not adhering to the admission agreement.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) TIrzah Hubbard conducted an Unannounced complaint visit on 08-10-21 and was met by the Business Office Manager to discuss the findings of the complaint.
Current census of the facility was: 108

The purpose of this visit was to complete this complaint investigation and deliver the findings to this facility.
Based on interviews and information gathered during the course of this investigation, it was revealed that this facility maintained lease agreement guidelines for persons in care. Based on an interview with Regional Officer and Business Manager it was learned the Manager did adhere to the agreement and fees due were accurate. In addition, interviews conducted with staff concluded that the facility applied the incentive and did not charge persons in care initial fees that were not agreed upon.

The preponderance of evidence standards has not been met. Therefore, the allegation was deemed to be UNFOUNDED.

Unfounded

Estimated Days of Completion: 30

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tirzah Hubbard	TELEPHONE: 559-365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021

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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