347005529-7-17-2023-27-AS-KHOS-CUAPPX-20230801113017

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005529
Report Date: 07/13/2023
Date Signed: 07/17/2023 03:52:06 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
03/20/2023 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230320084032

FACILITY NAME:	MEADOWS SENIOR LIVING, THE		FACILITY NUMBER:	347005529
ADMINISTRATOR:	ALYSSA SELLERS		FACILITY TYPE:	740
ADDRESS:	9325 E STOCKTON BLVD		TELEPHONE:	(916) 714-3755
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	160	CENSUS: 69	DATE:	07/13/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	ALYSSA SELLERS		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident was inappropriately placed in the facility's locked unit

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Kesha Lewis conducted an unannounced complaint visit to deliver findings to the facility . LPA met with Administrator ALYSSA SELLERS and explained the purpose of today’s visit.

Allegation 1 "Resident was inappropriately placed in the facility's locked unit" the allegation is found to be UNSUBSTANTIATED. Based on the signed statement of understanding R1 signed before entering the locked unit which is required as per health and safety code 1569.698 (F). A finding of unsubstantiated means that although the allegation may have happened, there is not a preponderance of evidence. Therefore the allegation is UNSUBSTANTIATED.

For future residents/ reference insure the signed statement of understanding is sent to the department.

Exit interview conducted. Copy of report given.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
03/20/2023 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230320084032

FACILITY NAME:	MEADOWS SENIOR LIVING, THE		FACILITY NUMBER:	347005529
ADMINISTRATOR:	ALYSSA SELLERS		FACILITY TYPE:	740
ADDRESS:	9325 E STOCKTON BLVD		TELEPHONE:	(916) 714-3755
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	160	CENSUS: 69	DATE:	07/13/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	ALYSSA SELLERS		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff is interfering with resident's visitation

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Kesha Lewis conducted an unannounced complaint visit to the facility on to deliver findings . LPA met with Administrator ALYSSA SELLERS and explained the purpose of today’s visit.

Based on interviews and information obtained, Allegation 1 "Staff is interfering with resident's visitation" the allegation is UNSUBSTANTIATED. All parties interviewed claimed there they were able to have visitor when they liked. LPA could not find any evidence to support the allegation.

A finding of unsubstantiated means that although the allegation may have happened, there is not a preponderance of evidence. Therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and copy of the report given.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

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

LIC9099 (FAS) - (06/04)

Page: 2 of 2