097001962-5-7-2024-59-AS-LMUZ-D59NRH-20240514104131

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 097001962
Report Date: 05/07/2024
Date Signed: 05/07/2024 02:31:01 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/16/2023 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20230816110147

FACILITY NAME:	OAK GROVE SENIOR CARE		FACILITY NUMBER:	097001962
ADMINISTRATOR:	OMITA KAHN		FACILITY TYPE:	740
ADDRESS:	2920 TAM O'SHANTER DRIVE		TELEPHONE:	(916) 939-0962
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	6	CENSUS: 2	DATE:	05/07/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Resident Care Coordinator Serge Entona		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Licensee did not maintain liability insurance
Licensee is in financial distress
Staff do not ensure facility has enough food to serve residents

INVESTIGATION FINDINGS:

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On 5/7/24, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Resident Care Coordinator Serge Entona.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

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 59-AS-20230816110147

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OAK GROVE SENIOR CARE	FACILITY NUMBER: 097001962
	VISIT DATE: 05/07/2024

NARRATIVE

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Licensee did not maintain liability insurance
Based on record reviewed, the department finds that the facility has current liability insurance on file with the department. Based on this information, the above allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.

Licensee is in financial distress
Based on Department Audit review there are no findings that the facility is in financial distress. The facility is generating enough income from the operation to cover the facility’s operational expenses. The facility is in compliance at this time. Based on this information, the above allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.

Staff do not ensure facility has enough food to serve residents
On 8/22/23 and 5/7/24, the Department did a walk-through of the kitchen and noted that the facility had the appropriate amount of food; 2 days of perishables and 7 days of nonperishable. Resident (2) and staff (2) interviews state that there is plenty of food being offered. Based on record review, food receipts, and observation, the department finds the facility to have an adequate amount of food at the facility. Based on this information, the above allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.

Exit interview was conducted with Resident Care Coordinator and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

LIC9099 (FAS) - (06/04)

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