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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001484
Report Date: 11/04/2020
Date Signed: 11/19/2020 02:06:03 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/13/2020 and conducted by Evaluator DeAnna Williams-Lyons
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20200813141855
FACILITY NAME:SUMMER'S RESIDENTIAL CARE HOMEFACILITY NUMBER:
347001484
ADMINISTRATOR:PAUL LOMENDEHEFACILITY TYPE:
740
ADDRESS:130 MANITOU STREETTELEPHONE:
(916) 567-0759
CITY:SACRAMENTOSTATE: CAZIP CODE:
95838
CAPACITY:5CENSUS: 5DATE:
11/04/2020
UNANNOUNCEDTIME BEGAN:
12:49 PM
MET WITH:Paul Lomendehe, LicenseeTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff failed to provide adequate care and supervision to resident
INVESTIGATION FINDINGS:
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On November 4, 2020, at 12:50 pm, Licensing Program Analyst (LPA) DeAnna Williams-Lyons delivered complaint findings to the facility by telephone due to Covid-19. LPA spoke with Licensee, Paul Lomendehe and explained the purpose of today's visit.

On 8/13/2020, the Sacramento Police was dispatched to the facility on the report of a missing person with dementia (R1). R1 was found wandering the area of Manitou Street, Sacramento 95838. R1 was returned to the facility by the police safely and did not require any medical attention. R1's LIC 602/physician's report dated 4/26/19, states R1 cannot leave the facility unassisted. LPA spoke with the Licensee about the allegation. The Licensee admits the allegation did happen and the facility is making extra efforts to make sure it doesn’t happen again.
Based on records reviewed, and the licensee admission, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Per California Code of regulations, Title 22 are being cited on the attached LIC 9099D.

Exit interview was conducted and copy of this report was provided to Paul Lomendehe.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020
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 27-AS-20200813141855
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SUMMER'S RESIDENTIAL CARE HOME
FACILITY NUMBER: 347001484
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2020
Section Cited
CCR
87705(c)(4)
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87705(c)(4) Care of Persons with Dementia. Licensees who serve residents with dementia shall ensure an adequate number of direct care staff to support each resident’s needs.

The Licensee admits the allegation did happen and the facility is making extra efforts to make sure it doesn’t happen again.
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Licensee shall ensure residents are supervised at all times including when residents go out into the community. Licensee shall submit a plan on how the facility will supervise residents who are unable to leave unassisted. Plan Of Correction shall be submitted to LPA by: 12/4/2020
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020
LIC9099 (FAS) - (06/04)
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