577000418-5-7-2021-21-AS-BMOS-C35QT2-20210518122623

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 577000418
Report Date: 05/07/2021
Date Signed: 05/07/2021 10:54:56 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/03/2021 and conducted by Evaluator Marisol Cuadra

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20210303154018

FACILITY NAME:	GRAND RIVER CARE CENTER-WEST		FACILITY NUMBER:	577000418
ADMINISTRATOR:	DANA SBARBARO		FACILITY TYPE:	740
ADDRESS:	509 MICHIGAN BOULEVARD		TELEPHONE:	(916) 373-1591
CITY:	WEST SACRAMENTO	STATE: CA	ZIP CODE:	95691
CAPACITY:	30	CENSUS: 12	DATE:	05/07/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Diana Paz (Administrator)		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility allowed dementia resident to move in without responsible parties knowledge
Facility threatened resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisol Cuadra conducted a complaint investigation regarding the above allegations. Tele-visit with Administrator, Diana Paz was conducted due to COVID-19 precautions on May 7, 2021 and on this date for the purpose of closing the complaint.

During this investigation LPA conducted interviews and reviewed records. It was alleged that facility allowed dementia resident to move in without responsible party knowledge. Responsible party indicated that they were given notice from facility that resident (R1) was going to be relocated to a new facility due to previous facility was closing. Although R1 was moved a month early than the original scheduled date and responsible party had concerns about new facility monthly rate because there is an outstanding balance from previous facility in the amount of $15,785 as of December 17, 2019. Administrator confirmed that facility gave notice to responsible party about the relocation of R1 to the new facility and offered them a list of financial options like Assisted Living Waiver that will help to lower their portion or caring.com which will also help to lower their monthly portion. LPA conducted interviews with Long Term Ombudsman who confirmed that they are actively involved to help them to resolve the situation.
Continues on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021

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 21-AS-20210303154018

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: GRAND RIVER CARE CENTER-WEST	FACILITY NUMBER: 577000418
	VISIT DATE: 05/07/2021

NARRATIVE

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Continued from LIC9099...

A finding that the complaint allegation Facility allowed dementia resident to move in without responsible parties knowledge is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation of Facility threatened resident. It was alleged that resident was threatened by Administrator that if admission agreement was not signed at that moment R1 will be left out in the street. However, LPA attempted to interview R1 in two occasions and offered them to speak in private, R1 refused to speak to LPA referring to responsible party and expressing that any questions should be directed to their responsible party only. During interviews conducted with Administrator indicated that R1 was never threatened to be left out in the street and provided notices of unpaid monthly fees letter from previous facility dated 9/26/19 which indicated that the facility will terminate the agreement upon 30 days written notice to responsible party and facility didn’t proceed with eviction at that time because they care for their residents and won’t leave residents out in the street. Facility provided a 30-day notice to pay or quit that was issued on 12/17/19 and it was served via personal service to R1 with different housing alternatives and care options but facility once again did not proceed with eviction.

A finding that the complaint allegation Facility threatened resident is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021

LIC9099 (FAS) - (06/04)

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