347005578-1-14-2021-27-AS-MSEY-BXAM8X-20210115082353

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005578
Report Date: 01/14/2021
Date Signed: 01/14/2021 03:32:17 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
10/29/2020 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 27-AS-20201029144739

FACILITY NAME:	SCANDIA CARE FOR ELDERLY II		FACILITY NUMBER:	347005578
ADMINISTRATOR:	HONG NGUYET TRINH		FACILITY TYPE:	740
ADDRESS:	3920 PLAINSFIELD WAY		TELEPHONE:	(916) 997-7668
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95821
CAPACITY:	6	CENSUS: 5	DATE:	01/14/2021
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Zoe Trinh		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident tested positive for illegal drug while in care.

INVESTIGATION FINDINGS:

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On 1/14/21, Licensing Program Analyst (LPA) Kevin Mknelly spoke Zoe Trinh of facility Scandia Care for Elderly II- facility number 347005578 at approximately 3 PM. LPA was unable to meet at the facility due to current circumstances.

LPA reviewed resident files and facility records.
LPA interviewed caregivers, resident family and the reporting party.
LPA finds that facility met Tittle 22 requirements.

The allegation that resident tested positive for illegal drugs arose from a hospital test when R1 was seen at the emergency department of an area hospital for a change of condition. Initial drug testing was positive for illicit drugs of which R1, who has dementia, did not have access. This triggered a Mandated Report. However, a subsequent test was

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021

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-20201029144739

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: SCANDIA CARE FOR ELDERLY II	FACILITY NUMBER: 347005578
	VISIT DATE: 01/14/2021

NARRATIVE

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administered on the same day to verify the initial finding. The second test was negative.

LPA confirmed the negative finding on 1/13/21 on a phone call with the reporting hospital social work department.

This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

Unable to obtain signature. Signature present on hard copy in file. LPA sent a copy of report for Administrator to sign. Administrator to send a signed copy back to CCL.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021

LIC9099 (FAS) - (06/04)

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