347005714-5-10-2021-25-AS-MSEY-C2VTEU-20210510144029

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005714
Report Date: 05/10/2021
Date Signed: 05/10/2021 12:03:42 PM

Unfounded

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
04/09/2021 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210409133459

FACILITY NAME:	CARE HORIZONS ASSISTED LIVING II		FACILITY NUMBER:	347005714
ADMINISTRATOR:	IORDACHE-STIR, DRAGOS A.		FACILITY TYPE:	740
ADDRESS:	6640 CARE LANE		TELEPHONE:	(916) 205-2273
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 6	DATE:	05/10/2021
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Adrian Iordache-Stir, Administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff are not treating residents with respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada contacted the facility via telephone to deliver findings to a complaint received on 4/9/2021. Findings are being delivered via telephone due to current Covid-19 precautionary measures in place. LPA spoke with Adrian Iordache-Stir, Administrator and explained the purpose of the call. During the investigation, LPA interviewed Administrator, (2) staff, (2) residents and an individual who knows resident (R1). LPA reviewed documents for R1 including: pre-placement appraisal, physician's report, care plan and admission agreement. The results of the investigation are as follows;

Interview with a resident (R2) who has lived at the facility for many years indicated that staff is always "very respectful" to residents and there are no issues between staff and residents. LPA was unable to interview additional residents due to those residents having a diagnosis of Dementia. Staff (S1/S2) and Administrator stated that they are always respectful to residents and other staff and have not witnessed any staff being disrespectful to a resident or to one another. An individual who knows R1 indicated that R1 has never complained about staff (S1) to her since moving in. Resident (R1) stated on 4/14/2021 that she has spoken to the Administrator and staff (S1) and resolved any concerns and there are currently none.

Based on information obtained, LPA finds the allegation 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. This complaint is being dismissed without any citations.

Exit interview. A copy of this report to be e-mailed to Administrator who agrees to print, sign and return a copy to the department today, 5/10/2021.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021

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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