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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 557000412
Report Date: 07/02/2024
Date Signed: 07/02/2024 01:02:23 PM

Unsubstantiated


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
04/05/2024 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20240405091022
FACILITY NAME:MEADOWVIEW MANORFACILITY NUMBER:
557000412
ADMINISTRATOR:N/AFACILITY TYPE:
740
ADDRESS:19227 SOUTH COURTTELEPHONE:
(209) 533-0935
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY:20CENSUS: 17DATE:
07/02/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Beatrice BurkettTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff are not ensuring that resident's toileting needs are met
Staff are not keeping the facility clean or sanitary
INVESTIGATION FINDINGS:
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On 7/2/24 at approximately 11:15 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to deliver findings related to a complaint investigation in to the above listed allegations. LPA Jensen met with Administrator Beatrice Burkett and explained the purpose of today's visit.

LPA Jensen met with Licensee Bea Schoon and explained the purpose of today's visit. During the course of the investigation LPA Jensen inspected the physical plant on 3 separate occasions, observed 3 meal services and interviewed 2 staff, 10 residents and 1 family member of a resident.

Allegation 1: Staff are not keeping the facility clean or sanitary
According to the Administrator there is a daily cleaning regimen and a weekly deep clean. The care staff also monitor all resident rooms throughout the day and clean and clean as needed.
*********************Continued on LIC 9099C****************************************************************************
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
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-20240405091022
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: MEADOWVIEW MANOR
FACILITY NUMBER: 557000412
VISIT DATE: 07/02/2024
NARRATIVE
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 LPA Jensen inspected the facility common areas, the resident bedrooms and the bathrooms on 3 separate occasions and observed the facility to be sanitary and free of odor. Based on LPA Jensen's observations during multiple unannounced site visits the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

Allegation #2: Staff are not ensuring that resident's toileting needs are met
LPA Jensen conducted interviews with staff, residents and a family member. 10 of 10 residents interviewed all stated the staff assist them toileting needs when required. The family member of the resident that was interviewed had no concerns regarding the care being provided at the facility. LPA Jensen conducted unannounced inspections on 3 separate occasions and did not detect incontinence odors. While it is possible that there has been an occasion wherein a residents toileting needs were not addressed in a timely manner, based on interviews conducted and LPA Jensen's observations, the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

An exit interview was conducted and a coy of this report, appeal rights and an LIC 811 were given.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2