392700366-12-6-2022-27-AS-KHOS-CM636W-20221215165900

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700366
Report Date: 12/01/2022
Date Signed: 12/06/2022 04:25:58 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, 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
10/25/2022 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20221025143049

FACILITY NAME:	COMMONS AT UNION RANCH, THE		FACILITY NUMBER:	392700366
ADMINISTRATOR:	DIANA BORZA		FACILITY TYPE:	740
ADDRESS:	2241 N UNION ROAD		TELEPHONE:	(209) 463-9100
CITY:	MANTECA	STATE: CA	ZIP CODE:	95336
CAPACITY:	135	CENSUS: 91	DATE:	12/01/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Sheri Kimbro		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff are not following COVID protocols

INVESTIGATION FINDINGS:

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Unannounced complaint visit made out to this facility on 12/01/2022 by this Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Sheri Kimbro, who was briefly interviewed.
It was reported that there were not any new cases of COVID positive individuals for this facility at this time.
Current census was 91 residents for both the Assisted Living and Memory Care units at this time.
The purpose of this visit was to deliver the findings to this facility, and its designated personnel, for this investigation and the above allegation.
Based on interviews conducted during the course of this investigation, it was learned that the decision to end communal dining, group activities, and outings into the community for all facility residents was made after it was learned that there were a total of (6) COVID positive cases for this facility. In order to curb this figure and not allow for the further spread of the COVID virus into the community, this facility decided to fall in line with the policies and procedures set forth in the Public Health Order (PHO) when faced with positive individuals. As a result, it was learned that several parties were either outraged at the decision to close the community down citing emotional distress for vulnerable individuals or were upset that this facility did not take

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Charlie Yang	TELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

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-20221025143049

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: COMMONS AT UNION RANCH, THE	FACILITY NUMBER: 392700366
	VISIT DATE: 12/01/2022

NARRATIVE

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quicker action to shut down operations.
Based on a review of the forms and documents gathered for this investigation, it was learned that this facility, and its staff, did follow all protocols and guidelines outlined in this facility's mitigation and infection control plan. Facility staff were required to mask at all times within the confines of this facility. Individuals who tested positive for COVID were isolated in their own rooms and facility staff were assigned specific tasks and duties related only to those individuals. Timelines were put into place before infected individuals were considered to be symptom free and eventually allowed back out to interact with other facility residents and staff.
It was learned that this facility was cleared by San Joaquin County Public Health and has not had another COVID positive case since 11/17/2022.

This agency has investigated the complaint allegation(s). This agency has found that the complaint was UNFOUNDED, meaning that the allegation(s) were false, could not have happened and/or was without a reasonable basis. This agency has therefore dismissed the complaint.

There were no deficiencies observed or cited during today’s complaint visit.

Exit Interview

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Charlie Yang	TELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

LIC9099 (FAS) - (06/04)

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