392700366-7-3-2023-27-AS-KHOS-CTFJWV-20230705072522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700366
Report Date: 05/12/2023
Date Signed: 07/03/2023 04:05:20 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
04/07/2023 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230407094219

FACILITY NAME:	COMMONS AT UNION RANCH, THE		FACILITY NUMBER:	392700366
ADMINISTRATOR:	SHERI KIMBRO		FACILITY TYPE:	740
ADDRESS:	2241 N UNION ROAD		TELEPHONE:	(209) 463-9100
CITY:	MANTECA	STATE: CA	ZIP CODE:	95336
CAPACITY:	135	CENSUS: 88	DATE:	05/12/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Karen Silva		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff do not place dementia residents in memory care unit.

Staff does not ensure resident is provided clothing.

INVESTIGATION FINDINGS:

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Unannounced complaint visit made out to this facility on 05/12/2023 by Licensing Program Analysts (LPAs) Charlie Yang and Kimberly Viarella who were met by the Resident Services Director Karen Silva.
Brief interview was conducted with the Resident Services Director since the facility designated Administrator, Sheri Kimbro, was unavailable at this time.
Current census was 88 residents.
The purpose of this complaint visit was to deliver the findings for this investigation unto the facility designated representative at this time.
Based on interviews and information gathered during the course of this investigation, it was learned that this facility did retain dementia diagnosed residents on the Assisted Living side of this facility. Based on interviews and information gathered, it was learned that these dementia diagnosed residents were assessed and found to be appropriate for placement in the Assisted Living side of this facility. It was learned that they were compatible in terms of care, service, and medication management needs except for serviced contracted through their own hospice agency.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Charlie Yang	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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-20230407094219

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: COMMONS AT UNION RANCH, THE	FACILITY NUMBER: 392700366
	VISIT DATE: 05/12/2023

NARRATIVE

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It was learned from facility staff that the care and supervision required for these dementia diagnosed residents did not interfere with the overall care needs for this facility as a whole and residents were treated with the same degree as those who were not diagnosed with dementia.
It was learned that there was a resident, R1, who was recently experiencing issues with some health related symptoms which required the intervention of licensed medical professionals and members of this facility's administrative team.
It was learned that R1 was not diagnosed with dementia at the time of this investigation.
It was learned that R1 would often times act out in an aggressive and intimidating tone but had never been observed, or reported, to have been physically aggressive or violent towards residents or facility staff at any given time.
It was learned that R1 had been observed to have emerged into this community from R1's room without a shirt, pants on some incidents, and was totally naked on other occasions. It was learned from interviews that steps were always taken by facility staff to make sure that R1 always had sufficient clothing on prior to going into the common areas of this facility where other facility residents congregated. It was learned that this was not always possible since R1 would come out into the community, sometimes later in the evenings, without the proper attire when staff were assisting other residents to bed or with ADLs.
It was learned that R1 was conserved and required additional assistance from R1's licensed medical professional. Steps were initiated by this facility to address these types of behaviors from R1 and progress was learned to have been made.
It was learned that facility staff were not allowed to dictate what R1 could or should not wear and had to strictly respect R1's wishes and overall personal rights at all times. It was learned that facility staff always made it a point to assist and redirect R1 when these types of issues took place but did not dictate to R1's behaviors. Respect and dignity were always maintained in regards to the other facility residents as well so that they were not regularly subjected to this type of behavior.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred.

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

Exit Interview

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Charlie Yang	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC9099 (FAS) - (06/04)

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