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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 577001215
Report Date: 03/28/2025
Date Signed: 03/28/2025 04:20:38 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/31/2025 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20250131093814
FACILITY NAME:UNIVERSITY RETIREMENT COMMUNITY AT DAVISFACILITY NUMBER:
577001215
ADMINISTRATOR:MARIA BURTONFACILITY TYPE:
741
ADDRESS:1515 SHASTA DRIVETELEPHONE:
(530) 747-7000
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:500CENSUS: 47DATE:
03/28/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria Burton, AdministratorTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff do not ensure that residents have adequate hygiene supplies
Staff do not follow infection control practices
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to complete the complaint investigation and deliver findings regarding the above allegations.
On 2/5/2025 and 3/28/2025 LPA Nakagawa made an inspection of the facility, touring both Assisted Living and Memory Care, and common areas of the facility including the large dining room upstairs, the downstairs entry, the library area and the entry to the outdoor pool, and the mailboxes. LPA spoke with staff (S1 – S9) asking if there were adequate hygiene supplies for residents for proper hygiene and infection control practices. Nine (9) out of (9) staff stated that there were adequate supplies, including soap, paper towels, gloves, masks and hand sanitizer.

Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
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 21-AS-20250131093814
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: UNIVERSITY RETIREMENT COMMUNITY AT DAVIS
FACILITY NUMBER: 577001215
VISIT DATE: 03/28/2025
NARRATIVE
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Continued from 9099.....

S1 stated “that there are ample supplies.” S2 provided an invoice showing that adequate supplies are ordered by the facility. LPA inspected storage areas for each department (housekeeping, Assisted Living, Memory Care) and found adequate supplies of gloves, cleaning supplies, toilet paper, paper towels, hand soap and PPE- with additional supplies stored in the basement. On 3/28/2025 LPA inspected the Memory Care Unit and six (6) out of the six (6) apartments inspected had soap, paper towels, covered trash cans and toilet paper. Three apartments in Assisted Living were also inspected and found adequate hygiene supplies in three (3) of three (3) units. In addition, LPA spoke with three (3) of three (3) residents who stated they were satisfied with the supply of hygiene supplies and that staff made sure they were well stocked. Therefore, the allegation that Staff do not ensure that residents have adequate hygiene supplies is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

In addition, the complaint alleges that Staff do not follow infection control practices. LPA visited the facility on 2/5/2025 and 3/28/2025 and found required Infection Control Protocols in place. Staff S3 stated that Staff receive trainings regularly and are provided with PPE to ensure safety for themselves and the residents. Signs are up reminding staff to wash hands regularly and hand sanitizer is available throughout the building. Five (5) Staff in Caregiving and Housekeeping were interviewed: five (5) of five (5) staff stated that they follow infection control practices, receive training, and have enough PPE available. They were asked if they would feel comfortable requesting another staff member to follow infection control practices if they were not and they stated “Yes, for their safety and the safety of the residents, they would.” In addition, the facility provides sick leave for staff when they are ill, so they do not come to work when they may be contagious. In addition, the facility regularly reports any outbreaks of possible infectious disease to CCL and the CDPH as required, and follows the protocols and procedures requested by the departments. Therefore, the allegation that staff do not follow infection control practices is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2