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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 500306146
Report Date: 11/29/2023
Date Signed: 11/29/2023 02:55:17 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/11/2023 and conducted by Evaluator Jason Lund
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20231011132107
FACILITY NAME:LAS PALMAS ESTATESFACILITY NUMBER:
500306146
ADMINISTRATOR:MILLER, KREGGFACILITY TYPE:
740
ADDRESS:1617 COLORADOTELEPHONE:
(209) 632-8841
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:89CENSUS: 0DATE:
11/29/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Kregg MillerTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not safeguard resident's personal items
INVESTIGATION FINDINGS:
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Licensing Program Analyst Jason Lund arrived unannounced to complete a complaint investigation. LPA met by Administrator Kregg Miller and explained the reason for the visit. Census:0
Regarding the allegation that staff did not safeguard resident's personal items: LPA obtained copies of the resident and staff roster, MAR and 602, incident reports and hospital discharge paperwork. S2 reported that “We’ve got sticky fingers here”, and that another resident was suspected of stealing other residents’ belongings, but they had been unable to prove it. Of the five residents interviewed, R1 and R4 reported either hearing about or experienced missing items or money themselves.
Based on LPA’s observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiency is being cited on the attached 809-D during this visit.
An exit interview was conducted, and copies of the report and appeal rights left.
Substantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 27-AS-20231011132107
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LAS PALMAS ESTATES
FACILITY NUMBER: 500306146
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2023
Section Cited
CCR
87218(a)
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87218(a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153
This requirement was not met by:
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The facility is closing on 11/29/2023
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Based on LPA’s observation and interview, the licensee did not respond to the need for a theft and loss program after identifying theft. This poses a potential Health, Safety or Personal Rights risk to residents in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/11/2023 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20231011132107

FACILITY NAME:LAS PALMAS ESTATESFACILITY NUMBER:
500306146
ADMINISTRATOR:MILLER, KREGGFACILITY TYPE:
740
ADDRESS:1617 COLORADOTELEPHONE:
(209) 632-8841
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:89CENSUS: 0DATE:
11/29/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Kregg MillerTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not respond to resident's call for assistance in a timely manner.
Staff did not seek medical attention for resident's injuries.
Staff did not treat resident with dignity or respect.
Staff did not follow medication order as prescribed.
Due to insufficient staffing, residents are assisting other residents.
INVESTIGATION FINDINGS:
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Regarding the allegation Staff did not respond to resident's call for assistance in a timely manner- LPA obtained copies of the resident and staff roster, R1’s MAR and 602, incident reports and hospital discharge paperwork. LPA Campbell interviewed three residents and none reported that staff ignored their pendant calls and only one resident reported they were slow to arrive.
Regarding the allegation that staff did not seek medical attention for resident's injuries- LPA obtained copies of the resident and staff roster, R1’s MAR and 602, incident reports and hospital discharge paperwork. The five residents interviewed (R1, R2, R3, R4 and R5), only R1, reported that their medical needs were ignored. R5 stated “This place is really nice.” And R4 stated “No, none of the staff have been mean or shouted to me”.
Administrator Kregg Miller refused to sign paperwork.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20231011132107
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: LAS PALMAS ESTATES
FACILITY NUMBER: 500306146
VISIT DATE: 11/29/2023
NARRATIVE
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Regarding the allegation, staff did not treat resident with dignity or respect- Only R1 reported that staff refused to call an ambulance for her. R3, R4 and R5 stated that they were either able to receive medical care when needed or provided examples of when 911 was contacted.

Regarding the allegation that staff did not give resident medications as prescribed- None of the residents interviewed reported that staff withheld their medication or gave incorrect medication. The MAR reviewed for R1 showed only one dose was missed and R1 admitted she had refused to take medication in the past. All other medication was provided to R1 as directed.

Regarding the allegation that staff did not meet reporting requirements- LPA Campbell searched for the incidents referred to by the reporting party and found that there were incident reports submitted correctly for resident injury or trips to the hospital.

Regarding the allegation that residents are assisting other residents due to insufficient staffing- Only one of the residents (R1) reported that staff do not assist them. R3 said that “If I need help, they will get it for me.” And R4 said that they did not have a problem getting help if they need it.

Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore this allegation is unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, no deficiencies cited. Exit interview was held and a copy of report was given.

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4