502701055-9-15-2021-27-AS-SDOB-C6WMBD-20210916092745

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502701055
Report Date: 09/08/2021
Date Signed: 09/15/2021 10:09:56 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
08/27/2021 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20210827131440

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: 7	DATE:	09/08/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Jasraj Bhatia		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Not enough staff to meet needs of residents
Facility not providing safe environment for residents
Facility not providing incontinent care
Facility increased cost of care without proper notification

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit to the facility on September 8, 2021 to deliver complaint findings. LPA identified herself and discussed the purpose of the visit with the Administrator Jasraj Bhatia.

Regarding the allegation facility does not have enough staff to meet needs of residents. This investigation is based on LPA's interview with Administrator and facility caretaker, facility staff schedule, review of resident medical file, and LPA observations. The facility currently has five residents, and there is always one caretaker at the facility to provide care for residents. The Administrator is also at the facility helping with care of the residents. LPA observed staff, and hospice nurses tending to residents. Therefore, the allegation Facility does not have enough staff to meet needs of residents is deemed UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

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 2

Control Number 27-AS-20210827131440

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: 09/08/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation that facility is not providing a safe environment for residents. The facility has several caretakers, and the Administrator is at the facility more than 40 hours per week. There is no reason to believe the facility is unsafe. Therefore, the allegation facility does not provide a safe environment for residents is deemed UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation that facility is not providing residents with incontinence care. This investigation is based on review of care notes, interview with caretaker, and LPA observations. LPA witnessed a hospice care nurse arrive to the facility to check on Resident 1 (R1). The hospice nurse came out about ten minutes later, and informed facility Administrator that R1 refused her incontinence care and refused to take her medications. The facility caretaker stated they attempt to change R1 daily, but she refuses. The facility Administrator gave copies of the care notes to LPA showing exactly how many times R1 refused her incontinence care. Therefore, the allegation Facility does not provide residents with incontinence care is deemed UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation facility is increasing costs without proper notification. This investigation is based on review of Admissions Agreement, interview with Administrator, and review of facility files. The facility is being taken over by a new licensee. The former licensee should have notified all residents, and their representative of the change 30 days prior to new licensee taking over. The new licensee has the right to update the Admissions Agreement including the rate charged if he gives 60 days written notice to residents and their representatives. The Admission’s Agreement has not changed since the new licensee took over the facility. There is no documentation that suggests the new licensee has attempted to change the rate that R1 is required to pay since he has taken over as licensee. Therefore, the allegation Facility does not provide residents with incontinence care is deemed UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

There are no deficiencies cited per Title 22 Regulations..Exit interview was conducted, and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2