347005529-2-17-2021-27-AS-KHOS-BYHLUJ-20210223080402

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005529
Report Date: 02/17/2021
Date Signed: 02/17/2021 09:33:46 AM

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
08/17/2020 and conducted by Evaluator Anthony Tuck

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200817215122

FACILITY NAME:	MEADOWS SENIOR LIVING, THE		FACILITY NUMBER:	347005529
ADMINISTRATOR:	STEPHANIE JOHNSON-YANCY		FACILITY TYPE:	740
ADDRESS:	9325 E STOCKTON BLVD		TELEPHONE:	(916) 714-3755
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	160	CENSUS:	DATE:	02/17/2021
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:			TIME COMPLETED:	09:35 AM

ALLEGATION(S):

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Facility staff failed to notify responsible party of suspected abuse of resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anthony Tuck contacted facility via telephone to speak with Executive Director (ED) Barbara Fleck due to a not being allowed to conduct physical visits at this time due to the COVID-19 Pandemic. LPA explained the reason for the call and to conclude a complaint investigation and deliver the findings.
LPA reviewed copies of received documents pertaining to the prior compliant and reviewed original complaint files and findings. LPA reviewed a copy of the requested POA. LPA reviewed the current LIC 802 allegation and complaint description. LPA learned that the Power of Attorney (POA) and the Reporting Party (RP) are not the same individual. LPA learned that the RP was contacted by facility staff found on LIC 624.
This agency has investigated the allegation listed above. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint. Exit interview was conducted with Barbara Fleck. Copy of the report sent to Barbara via e-mail with a "read receipt" to verify the LIC 9099 was received. Barbara is to print out the report, sign it, and fax a signed copy to LPA at 916-263-4744.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (209) 242-5200
LICENSING EVALUATOR NAME: Anthony Tuck	TELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021

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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