347005578-1-14-2021-27-AS-MSEY-BXAM2H-20210115081335

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005578
Report Date: 01/14/2021
Date Signed: 01/14/2021 03:08:47 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
05/26/2020 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 27-AS-20200526134455

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:	02:30 PM
MET WITH:			TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Licensee continued to charge resident after resident relocated.

INVESTIGATION FINDINGS:

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On 1/14/21, Licensing Program Analyst (LPA) Kevin Mknelly spoke to "Zoe" Trinh, of Scandia Care for Elderly II- facility number 347005578 at approximately 2:30 PM. LPA was unable to meet at the facility due to current circumstances.

The department reviewed resident files for R1 and facility records.
Department auditor interviewed facility staff and resident’s payee.
LPA finds that facility met Tittle 22 requirements.

The department’s audit found that R1 had moved from this facility to another assisted living home on 12/7/18. R1 then lived at that facility until approximately the end of March 2019. That facility was in the process of a change of ownership. The change of ownership to that facility’s current licensee concluded on 4/3/19.

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)

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Control Number 27-AS-20200526134455

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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Therefore, as R1 was not a resident of this facility at the time of the alleged over-billing, this allegation is unfounded.

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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