577000881-12-3-2020-21-AS-HDBI-BX82LC-20210112162915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 577000881
Report Date: 12/03/2020
Date Signed: 12/03/2020 04:44:13 PM

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
02/19/2020 and conducted by Evaluator Katrina Walters

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20200219143001

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:	DATE:	12/03/2020
		UNANNOUNCED	TIME BEGAN:	03:59 PM
MET WITH:	Ashlee Sloan		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility is overcharging resident.

Illigal Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst's (LPA) Walters conducted a complaint investigation regarding the above allegations on this date. LPA spoke with Administrator, Ashlee Sloan, this date, for the purpose of delivering findings by phone due to the COVID – 19 precautions. The reader is advised that this visit was not conducted in person.

LPA previously conducted a virtual facility visit on 2/20/2020, at which time LPA reviewed records and received statements. It was alleged that the facility overcharged resident and that the facility is unlawfully evicting resident. Investigation revealed, R1 moved into the facility in 2019, at that time R1 was evaluated by facility and established that R1 required a higher level of care, level 5. R1 was re-evaluated and the level of care increased to level 6, meaning that the additional services were needed and/or would be provided by facility.

Continued on 9099c

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina Walters	TELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2020

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-20200219143001

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: 12/03/2020

NARRATIVE

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Charting notes from 06/13/2019- 08/07/2019 indicate that R1 required additional assistance from staff with care and housekeeping. In addition, facility assessment’s completed by the facility Nurses, indicate that additional services were needed. Facility Nurse, Brooke Hanson stated that resident was refusing care, but facility continued to offer services. The Administrator, Ashlee Sloan has also stated that R1 is denying the facility access to obtaining any further medical assessments by their physician. The facility is unable to determine what other needs or services the resident may require.
Due to rent dispute R1 withheld rent. The facility issued an eviction notice due to non-payment in December of 2019. R1 since has paid rent. Payment dispute has since been resolved. Eviction was valid.

Based on the information provided over the course of this investigation LPA Walters has determined that the allegations: That Facility is overcharging resident and Illegal Eviction are unsubstantiated. Meaning 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. Exit interview conducted at 4:00 PM.

This report was emailed to facility to obtain signature.

No citations issued.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina Walters	TELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2020

LIC9099 (FAS) - (06/04)

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