502701055-8-1-2023-27-AS-SRIN-CUQML2-20230815094138

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502701055
Report Date: 08/01/2023
Date Signed: 08/01/2023 03:28:58 PM

Unsubstantiated

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
03/03/2023 and conducted by Evaluator Jason Lund

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230303162049

FACILITY NAME:	ASPEN VILLE CO		FACILITY NUMBER:	502701055
ADMINISTRATOR:	BHATIA, JASRAJ		FACILITY TYPE:	740
ADDRESS:	5412 KIERNAN AVENUE		TELEPHONE:	(669) 265-4603
CITY:	SALIDA	STATE: CA	ZIP CODE:	95368
CAPACITY:	32	CENSUS: 28	DATE:	08/01/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Administrator Jasraj Bhatia		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff are not ensuring resident is bathed
Staff do not ensure resident has prescribed medication
Staff do not maintain a comfortable room temperature for residents
Staff do not ensure that resident's personal belongings are safeguarded
Staff do not ensure that resident has a working call button

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA met with Administrator Jasraj Bhatia and explained the reason for today’s visit. Census 28

Staff are not ensuring resident is bathed- Based on records review, interviews with staff, residents in care, and RP. Facility records indicate that residents did get their scheduled showers. Resident (R1) refused showers so that other residents in care could get showers instead. Staff interviewed state that residents in the care get showers twice a week or as necessary. Residents interviewed, state they did get showers twice a week or as necessary.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

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-20230303162049

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: ASPEN VILLE CO	FACILITY NUMBER: 502701055
	VISIT DATE: 08/01/2023

NARRATIVE

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Based on records review, interviews with staff, residents, and RP. the information provided; it was unclear if staff are not ensuring resident is bathed in care therefore the allegation was deemed UNSUBSTANTIATED.

Staff do not ensure resident has prescribed medication- Based on records reviewed and interviews with staff, residents in care and RP. Resident (R1) would order own medications and would not let the facility order medications. R1 stated that “R1 did refuse medications because was filling better not taking medications everyday.” Staff and residents interviewed stated that no residents have missed any medications. Staff order all medications for residents in care.

Based on facility records review, interviews with staff, residents and RP information provided, it was unclear if staff do not ensure resident has prescribed medication therefore the allegation was deemed UNSUBSTANTIATED.

Staff do not maintain a comfortable room temperature for residents- Based on interviews with staff, residents, RP and LPA Lund’s observation. LPA observed the facility temperature on 7/21/2023 & 8/1/2023 to within regulations of CCL. Staff & residents interviewed stated the facility temperature has always been confrontable, not to hot or too cold.

Based on interviews with staff, residents, RP and LPA’s Lund observation the information provided, it was unclear if staff do not maintain a comfortable room temperature for residents therefore the allegation was deemed UNSUBSTANTIATED.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230303162049

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: ASPEN VILLE CO	FACILITY NUMBER: 502701055
	VISIT DATE: 08/01/2023

NARRATIVE

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Staff do not ensure that resident's personal belongings are safeguarded- Based on records reviewed and interviews with staff, residents in care and RP. Resident (R1) filled out an LIC621 Client/Resident Personal Property and Valuables date 1/31/2023. R1 claimed that on 3/21/2023 that the facility lost R1’s T-Shirts. On 3/22/2023 the T-Shirts were found in R1’s closet. R1 stated that R1 left the facility with all possessions. Residents interviewed stated that their belongings have been safe at the facility. Staff interviewed stated that the facility washes each residents’ clothes independently.

Based on facility records review, interviews with staff, residents and RP information provided, it was unclear if staff do not ensure that resident's personal belongings are safeguarded therefore the allegation was deemed UNSUBSTANTIATED.

Staff do not ensure that resident has a working call button- Based on interviews with staff, residents, RP and LPA Lund’s observation. LPA observed the facility call button to work properly, when residents push the call button to much the system will jam. Staff have informed residents not to jam the system. Residents in care have two more options as well to use to get staff care, an cowbell or their cell phone.

Based on interviews with staff, residents, RP and LPA’s Lund observation the information provided, it was unclear if staff do not ensure that resident has a working call button therefore the allegation was deemed UNSUBSTANTIATED.

The Department (CCLD) has found the allegations. Unsubstantiated.
A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted with Administrator Jasraj Bhatia and report left.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

LIC9099 (FAS) - (06/04)

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