392700473-12-21-2021-27-AS-SDOB-C9Y7AB-20211222202917

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700473
Report Date: 12/17/2021
Date Signed: 12/21/2021 05:38:26 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
06/09/2021 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20210609114659

FACILITY NAME:	MANTECA RTRMT COM-HAPPY LVNG BY COGIR/COGIR MANTEC		FACILITY NUMBER:	392700473
ADMINISTRATOR:	SHERYL BRAVO		FACILITY TYPE:	740
ADDRESS:	430 NORTH UNION RD		TELEPHONE:	(209) 823-0164
CITY:	MANTECA	STATE: CA	ZIP CODE:	95337
CAPACITY:	84	CENSUS:	DATE:	12/17/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Sheryl Bravo		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff physically abused resident
Facility did not seek medical assistance for resident
Resident's possessions have gone missing
Facility removed information regarding Ombudsman from facility
Facility prevents residents from leaving their apartments
Food service is inadequate at facility

INVESTIGATION FINDINGS:

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Unannounced complaint visit made out to this facility on 12/17/2021 by LPA Charlie Yang. This LPA was met by the facility designated Administrator Sheryl Bravo who was briefly interviewed.
Current census was 50 residents of which 10 were from the memory care unit.
The purpose of this visit was to present the findings of this complaint investigation to this facility and its representative at this time.
Based on interviews of facility staff and residents, it was learned that this incident took place between R1 and S1 back in February of 2021. It was learned that S1 discovered that R1 had gone into another residents room and should not have been there in the first place. When confronted by S1 about being in the wrong room, R1 became aggressive and physically approached S1. R1 grabbed at S1's arm which resulted in R1 falling back when S1 instinctively pulled away from the aggressive act. There weren't any injuries sustained from this incident for the resident and staff alike. Facility staff, S2, did go ahead and contact for medical assistance and R1 was transported to the local hospital where an assessment was conducted and returned to this facility later that evening without any further issues.

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: 12/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

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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Control Number 27-AS-20210609114659

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: MANTECA RTRMT COM-HAPPY LVNG BY COGIR/COGIR MANTEC	FACILITY NUMBER: 392700473
	VISIT DATE: 12/17/2021

NARRATIVE

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Based on a tour of the facility, it was observed that there were several posters with information about the Long Term Care Ombudsman present throughout. It was observed that the relevant information for reporting and submitting complaints and concerns to the office of the Ombudsman was present and available.
Based on interviews with facility residents, it was learned that all resident rooms were locked with a key. This key was under the ownership of the facility resident and they were allowed to come and go as they pleased during the day and up until normal business hours. Interviews revealed that they did not feel hindered in their movements nor were they restricted by facility personnel.
Based on interviews with facility residents, it was learned that meals were served promptly with alternatives if desired. It was learned that dining could be done so in the main dining hall or in a resident's room if he/she chose to do so. Tray service would be provided if a resident did not feel like going out to eat in the main dining area. Interviews revealed that there was a variety to the meals that were being served and was adequate to meet the needs of the residents at this time.
A review of the facility's theft/loss policy was conducted from the program that was submitted. A review of all incident reports, involving theft/loss, was conducted dating back to the beginning of the year from January of 2021. It was learned that there have not been any reported thefts/loss stemming from resident reports since that time frame.
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: 12/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

LIC9099 (FAS) - (06/04)

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