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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 03:00:29 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
09/22/2023 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20230922131747
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:
09:51 AM
MET WITH:Administrator Kregg MillerTIME COMPLETED:
09:52 AM
ALLEGATION(S):
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Facility staff did not know whereabouts of resident

Facility staff did not provide transportation
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Le Ann Blocker Resident Coordinator and explained the reason for the visit.

Facility staff did not know whereabouts of resident- LPA Lund reviewed facility records interviewed staff and reporting party (RP) regarding Resident (R1). RP stated that R1 showed at reporting party’s location confused and disoriented. RP called Las Palmas Estates and spoke with a staff member who stated R1 could walk back to the facility and hang up on RP. RP gave a ride back to R1 to the facility. R1’s LIC602A dated 7/29/2008 states that R1 has mild cognitive impairment. The facility did not update R1’s LIC602A since 7/29/2008 and R1’s diagnosis may have changed since.
Administrator Kregg Miller refused to sign paperwork
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 5
Control Number 27-AS-20230922131747
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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Based on resident (R1) facility records and interview with reporting party the information provided, it clear that the facility staff did not know whereabouts of resident therefore the allegation was deemed SUBSTANTIATED.

Facility staff did not provide transportation- LPA Lund reviewed facility records interviewed staff and reporting party (RP) regarding Resident (R1). RP stated that R1 showed at reporting party’s location confused and disoriented. RP called Las Palmas Estates and spoke with a staff member who stated R1 could walk back to the facility and hang up on RP. RP gave a ride back to R1 to the facility. R1’s LIC602A dated 7/29/2008 states that R1 has mild cognitive impairment. The facility did not update R1’s LIC602A since 7/29/2008 and R1’s diagnosis may have changed since. When RP called the facility the didn’t come pick up R1 when R1 was confused and disoriented.

Based on resident (R1) facility records and interview with reporting party the information provided, it clear that the facility staff did not provide transportation therefore the allegation was deemed SUBSTANTIATED.

As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.
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: 2 of 5
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
09/22/2023 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20230922131747

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:
09:51 AM
MET WITH:Administrator Kregg MillerTIME COMPLETED:
09:52 AM
ALLEGATION(S):
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2
3
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5
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8
9
Facility staff did not assit resident with scheduling of medical appointment
INVESTIGATION FINDINGS:
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Facility staff did not assist resident with scheduling of medical appointment- LPA Lund reviewed resident (R1) facility records and interviewed witness. R1 had Turning Point to help with scheduling medical appointments. LPA interviewed a witness who stated was not aware of any appointments for R1.

Based on resident (R1) facility records and interview with witness the information provided, it was unclear if Facility staff did not assist resident with scheduling of medical appointment therefore the allegation was deemed UNSUBSTANTIATED.

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 5
Control Number 27-AS-20230922131747
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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Facility staff did not assist resident with scheduling of medical appointment- LPA Lund reviewed resident (R1) facility records and interviewed witness. R1 had Turning Point to help with scheduling medical appointments. LPA interviewed a witness who stated was not aware of any appointments for R1.

Based on resident (R1) facility records and interview with witness the information provided, it was unclear if Facility staff did not assist resident with scheduling of medical appointment therefore the allegation was deemed UNSUBSTANTIATED.
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 5
Control Number 27-AS-20230922131747
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 A
CCR
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(a) The facility shall determine the amount of supervision necessary by assessing the mental status of the prospective resident to determine if the individual:(1) tends to wander;(2) is confused or forgetful;
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The facility will close on 11/29/2023
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This requirement was not met by: The facility staff didn't know the where abouts of R1. This poses an immediate health and safety risk to persons in care.
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Type A
11/30/2023
Section Cited
CCR
87466
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The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs.....
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The facility will close on 11/29/2023
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This requirement was not met by: The facility staff did not provide transportation for R1. This poses an immediate health and safety risk to persons 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: 5 of 5