392700366-4-2-2021-27-AS-LKIG-BZV5UC-20210407201544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700366
Report Date: 04/02/2021
Date Signed: 04/02/2021 01:52:48 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
11/30/2020 and conducted by Evaluator Bruce Jacobs

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20201130140700

FACILITY NAME:	COMMONS AT UNION RANCH, THE		FACILITY NUMBER:	392700366
ADMINISTRATOR:	MAUREEN BRADLEY		FACILITY TYPE:	740
ADDRESS:	2241 N UNION ROAD		TELEPHONE:	(209) 463-9100
CITY:	MANTECA	STATE: CA	ZIP CODE:	95336
CAPACITY:	135	CENSUS: 92	DATE:	04/02/2021
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Maureen Bradley, Executive Director		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Resident (R-1) sustained a wound due to neglect.

Facility is not following doctor's orders.

INVESTIGATION FINDINGS:

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LPA Bruce Jacobs delivered complaint findings for the allegations listed above to Maureen Bradley, Executive Director of the facility.

The investigation was conducted by LPA Jacobs consisted of interviews with the Executive Director, facility staff, resident (R-1) and other witnesses at the care home. Facility site inspections were conducted and facility and resident records were requested, obtained and reviewed. The investigation concluded that the resident (R-1) sustained an minor (1 cm x 1 cm) skin tear to the back of her leg, likely caused by her wheelchair. Care staff observed the injury the evening of 11/16/21, reported to the facility nurse the following day. The resident's doctor was contacted, wrote an order for Home Health and Home Health treated the injury that healed in around 3 weeks. There was one order from the doctor and that order was followed in a timely manner.

This agency has investigated the above listed allegation and determined that there no evidence that he injury to the resident was caused by neglect or that the facility did not follow the doctor's order(s). Therefore, these allegations are without a reasonable basis and determined to be UNFOUNDED.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce Jacobs	TELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2021

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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