577000881-6-12-2020-21-AS-BMOS-BQQT7K-20200619142851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 577000881
Report Date: 06/11/2020
Date Signed: 06/12/2020 11:01:48 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
08/19/2019 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20190819101152

FACILITY NAME:	ATRIA COVELL GARDENS		FACILITY NUMBER:	577000881
ADMINISTRATOR:	KELLY FREDRICKSON		FACILITY TYPE:	740
ADDRESS:	1111 ALVARADO AVE		TELEPHONE:	(530) 756-0700
CITY:	DAVIS	STATE: CA	ZIP CODE:	95616
CAPACITY:	210	CENSUS: 131	DATE:	06/11/2020
		UNANNOUNCED	TIME BEGAN:	04:28 PM
MET WITH:	Ashlee Sloan		TIME COMPLETED:	04:59 PM

ALLEGATION(S):

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Facility is overcharging resident.

INVESTIGATION FINDINGS:

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The Department conducted a complaint investigation regarding the above captioned allegations. Licensing Program Analyst (LPA) A. Canela spoke with Administrator, Ashlee Sloan, this date, for the purpose of delivering findings by phone due to the COVID – 19 precautions.

LPA previously reviewed records and received statements. It was alleged facility overcharged resident. Investigation revealed, R1 moved into the facility with R2(spouse) in 2017, in which R1 was evaluated by facility and placed as requiring a higher level of care, level 2. R1 was re-evaluated the following month and the level of care decreased to level 0, meaning that no additional services were needed and/or would be provided by facility. R1 was no longer charged the additional fees for a higher level of care from 8/15/2017 to 2/19/2019. R1 was in the hospital a short time and returned to the facility on 4/2/2019, it was said by facility staff, R1 required a great deal of services.

Continue report see LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2020

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-20190819101152

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: ATRIA COVELL GARDENS	FACILITY NUMBER: 577000881
	VISIT DATE: 06/11/2020

NARRATIVE

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The facility conducted a resident Functional needs assessment that same day (4/2/2019) for R1 and determined R1’s total point system count placed him at a personal care level 3. The assessment for a higher level of care was signed that same day by resident service director S3 and R1’s responsible party, R2.
R2 corroborated to LPA that she had been providing these services and was able to assist R1 and felt she should not have to pay for additional services. R2 requested and received a letter signed by R1’s and R2’s Primary Physician, stating R2 was able to assist with R1’s self-care, transportation, grooming and bathing on 6/18/2019.
R1 and R2 live in a licensed assisted facility and R1’s care is to be provided by facility staff as the facility is responsible for resident care needs.
R2 expressed the facility never provided any services as she declined for assistance. Facility provided monthly assignment report which shows internal codes documenting facility did provide some assistance; it was also documented that on several occasions the assistance was not completed by staff, but completed by the family; completed by other; completed by resident or that resident refused.

The Department has investigated the above allegation and determined, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

This report was emailed to facility to obtain signature.

No citations issued.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2020

LIC9099 (FAS) - (06/04)

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