347005580-1-17-2025-59-AS-LMUZ-DD732F-20250122165150

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005580
Report Date: 01/17/2025
Date Signed: 01/17/2025 11:00:31 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/10/2025 and conducted by Evaluator Cassandra Mikkelson

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20250110164045

FACILITY NAME:	MOUNTAIN MANOR SENIOR RESIDENCE		FACILITY NUMBER:	347005580
ADMINISTRATOR:	DARRELL PRICE		FACILITY TYPE:	740
ADDRESS:	6101 FAIR OAKS BLVD		TELEPHONE:	(916) 488-7211
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	33	CENSUS: 15	DATE:	01/17/2025
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Executive Director, Darrell Price		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Staff inappropriately spoke to resident in care.

INVESTIGATION FINDINGS:

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Licensed Program Analyst (LPA) Cassandra Mikkelson and Licensed Program Manager (LPM) Laura Munoz arrived at the facility to conduct a complaint investigation. LPA and LPM met with Executive Director Darrell Price and explained the purpose of today's visit.

This property is divided into (2) two sections. The assisted living (AL) section is licensed by CCL and the skilled nursing (SN) section is licensed by Department of Public Health. Mr. Price provided a resident roster to LPA and LPM. Based on the resident roster, the resident who is the subject to this complaint resides on in SN. Staff are not shared between AL and SN of the facility.
Based on interviews conducted and records reviewed, the allegation that staff inapproriately spoke to residents in care did not occur in AL therefore the above allegation is found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted with Administrator. A copy of this report was provided.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

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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