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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005546
Report Date: 04/26/2023
Date Signed: 04/26/2023 04:11:20 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
04/18/2023 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20230418164641
FACILITY NAME:CORINA ELDERLY HOME 2FACILITY NUMBER:
347005546
ADMINISTRATOR:DRAGNEA, CORINAFACILITY TYPE:
740
ADDRESS:9411 SKYDOME STREETTELEPHONE:
(916) 215-0365
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 6DATE:
04/26/2023
UNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Corina DragneaTIME COMPLETED:
04:31 PM
ALLEGATION(S):
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Facility does not have sufficient staffing to meet the needs of the residents in care.
INVESTIGATION FINDINGS:
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On 4-26-23 at 1:13pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to open and conduct an investigation for the allegation noted above. LPA met with Administrator Corina Dragnea and explained the purpose of the visit. During this investigation, LPA interviewed 6 residents in care, 2 staff members, and Administrator. LPA also reviewed facility staffing schedule, staffing charts, and conducted a facility observation. Based on interviews, record reviews, and observation, it was revealed that this facility provides care for 6 residents of which 3 are receiving hospice services. Additionally, based on record review it was revealed that at least 2 staff members are on duty during the day shift and 1 staff on duty during the night shift including scheduled days off. LPA observed staff to be providing assistance adequately and efficiently based on residents' needs and requests. Resident and staffing Interviews conducted did not reveal or indicate corroborated statements of staff not meeting the needs of residents in care based on staffing levels.

{Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
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
Control Number 27-AS-20230418164641
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: CORINA ELDERLY HOME 2
FACILITY NUMBER: 347005546
VISIT DATE: 04/26/2023
NARRATIVE
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As a result of this investigation, it is determined that there is not a preponderance of evidence to conclude that facility does not have sufficient staffing to meet resident needs, therefore, this allegation is UNSUBSTANTIATED.

An exit interview was conducted with Administrator Corina Dragnea and a copy of this report was provided to Corina. Appeal rights provided.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2