577001215-12-19-2023-21-AS-KMOA-CZ72F7-20240104162103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 577001215
Report Date: 12/19/2023
Date Signed: 12/19/2023 02:09:39 PM

Unfounded

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
12/18/2023 and conducted by Evaluator Jill Nakagawa

COMPLAINT CONTROL NUMBER: 21-AS-20231218124819

FACILITY NAME:	UNIVERSITY RETIREMENT COMMUNITY AT DAVIS		FACILITY NUMBER:	577001215
ADMINISTRATOR:	MARIA BURTON		FACILITY TYPE:	741
ADDRESS:	1515 SHASTA DRIVE		TELEPHONE:	(530) 747-7000
CITY:	DAVIS	STATE: CA	ZIP CODE:	95616
CAPACITY:	500	CENSUS: 45	DATE:	12/19/2023
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Maria Burton, Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff are not ensuring that facility grounds are maintained in a safe manner for resident(s) in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced and met with Maria Burton, Administrator to deliver findings of a complaint investigation regarding the allegation "Staff are not ensuring that facility grounds are maintained in a safe manner for resident(s) in care. LPA toured the facility and interviewed staff.

LPA observed during the facility tour on 12/19/2023 that the allegation listed in the complaint is located on the Independent Living (IL) portion of the facility.

Continued on 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill Nakagawa	TELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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-20231218124819

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: 12/19/2023

NARRATIVE

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Continued from 9099.....

Community Care Licensing (CCL) does not have jurisdiction to enforce regulations on that portion of the facility. Based on the investigation, LPA was unable to identify any deficiencies in the maintenance of the property on the Assisted Living (AL) side of the facility that CCL does have jurisdiction.

This agency has investigated the complaint allegation "Staff are not ensuring that facility grounds are maintained in a safe manner for resident(s) in care". After interviews, observations, and other investigation the agency has found that the allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies were cited.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill Nakagawa	TELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC9099 (FAS) - (06/04)

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