392700366-7-16-2023-27-AS-LKIG-CTXQT8-20230721122643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700366
Report Date: 05/12/2023
Date Signed: 07/16/2023 09:04:36 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
01/12/2023 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230112093904

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:	01:00 PM
MET WITH:	Karen Silva		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff did not protect resident from being inappropriately touched by another resident.

Facility staff did not supervise residents resulting in inappropriate interaction.

Facility staff left resident in soiled feces.

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 R1 and R2 were both residents of this facility's memory care unit. It was learned that both residents were aware of one another's presence and often times were observed by facility staff to be around one another and in close proximity at times. It was learned that facility staff observed R1 and R2 holding hands as well on some occasions. This type of behavior was also observed by facility staff between R2 and other residents in the memory care unit as well. This type of behavior was not deemed to be aggressive, forced, or unwelcomed as

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-20230112093904

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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observed by facility staff.
It was learned from facility staff that R1 was a very strong minded, strong willed, and very vocal individual. It was learned that R1 would strongly voice any concerns or dislike if faced with a situation where R1 was uncomfortable or had any reservations at any given time.
It was learned from interviews that the relationship between R1 and R2 was consensual without coercion by either party involved.
It was learned that R1 invited the attention and sought the affection of R2 and the same sentiments were returned in kind by R2.
A tour of the facility's memory care unit was conducted. This LPA did not notice any issues related to incontinence of bowel and bladder specifically with smells and lingering odors.
Based on interviews and information gathered during the course of this investigation, it was learned that there were certain residents who were uncooperative and resistant to staff intervention when attempting to change residents out of soiled depends.
It was learned that several attempts, maybe up to (5) sometimes, had to be made in order to successfully change these certain residents out of their soiled depends. This would sometimes appear that residents were left in soiled depends but attempts were always under way to address these issues to make sure that residents were changed, cleaned, and put into fresh depends.

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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