347005703-10-12-2021-25-AS-LMUZ-C7W6WD-20211017211010

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005703
Report Date: 10/12/2021
Date Signed: 10/12/2021 04:29:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/02/2021 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 25-AS-20210602131023

FACILITY NAME:	CARMEN ELDERLY CARE		FACILITY NUMBER:	347005703
ADMINISTRATOR:	ION, CARMEN		FACILITY TYPE:	740
ADDRESS:	7548 ALMONDWOOD AVE		TELEPHONE:	(916) 223-5435
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	4	CENSUS: 3	DATE:	10/12/2021
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Carmen Ion		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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-Neglect/Lack of Supervision
-Food Service
-Personal Rights

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 10/12/21 to provide complaint findings. LPA met with staff and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Upon arrival LPA completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility. LPA requested for staff to notify Administrator that LPA is present.

LPAs reviewed facility records and conducted interviews.
The department finds that facility met Tittle 22 requirements.

During the course of the investigation, three (3) inspections to the facility were conducted in which food supplies were sufficient, resident care was being provided as needed and residents’ personal rights were being respected.

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: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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 25-AS-20210602131023

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: CARMEN ELDERLY CARE	FACILITY NUMBER: 347005703
	VISIT DATE: 10/12/2021

NARRATIVE

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LPA Mknelly interviewed the person who originally filed the complaint. That person stated that their intent was not to file a complaint; rather, it was an attempt to get personal assistance with financial and housing issues. They recanted the complaint stating that the licensee treated her very well.

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.

Exit interview conducted and report provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC9099 (FAS) - (06/04)

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