092700840-4-26-2023-25-AS-LMUZ-CRA3BR-20230426180647

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 092700840
Report Date: 04/26/2023
Date Signed: 04/26/2023 10:09:52 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
09/09/2022 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 25-AS-20220909161911

FACILITY NAME:	VILLAGE OAKS SENIOR CARE, LLC		FACILITY NUMBER:	092700840
ADMINISTRATOR:	FOULK, BENJAMIN L.		FACILITY TYPE:	740
ADDRESS:	1011 ST. ANDREWS DRIVE		TELEPHONE:	(916) 293-1981
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	15	CENSUS: 10	DATE:	04/26/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Administrator Rod Fleeman		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Facility administrator lacks current qualifications.
Facility does not have back up food supplies.
Facility does not ensure that residents are adequately fed.
Facility staff does not ensure that residents receive medications on time.
Administrator does not spend a sufficient amount of time at the facility.

INVESTIGATION FINDINGS:

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On 4/26/2023, Licensing Program Analysts (LPAs) Lavinia Muscan and Melissa Parks arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Rod Fleeman.

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:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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 25-AS-20220909161911

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: VILLAGE OAKS SENIOR CARE, LLC	FACILITY NUMBER: 092700840
	VISIT DATE: 04/26/2023

NARRATIVE

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Facility administrator lacks current qualifications.
Administrator does not spend a sufficient amount of time at the facility.
During the course of the investigation, LPAs reviewed administrator qualification, staff time sheets, and obtained copies of facility documentation. The current facility administrator does have a valid administrator certificate, and certificates were obtained prior to assuming the role as administrator. Facility documents show that the Administrator is at the facility every day and as needed. Documents also show there is sufficient staff at the facility to meet the residents needs. Based on staff interviews and the information received, LPAs find the above allegations to be UNFOUNDED meaning that the allegation are false, could not have happened, and/or are without a reasonable basis.

Facility does not have back up food supply.
Facility does not ensure that residents are adequately fed.
During the course of the investigation, LPAs observed the food supply area and refrigerators. The facility has shown to have adequate amounts of 2 days of perishable foods and 7 days of non-perishable foods for residents. Interviews with residents revealed that the residents get additional servings during meals if requested and snacks throughout the day. Therefore, the finding for these allegations is UNFOUNDED meaning that the allegations are false, could not have happened, and/or are without a reasonable basis.

Facility does not ensure that residents have medications on time.
LPAs have reviewed medications, interviewed 5 staff and interviewed 2 residents. At this time, LPAs are not able to prove that there are any medications missing from the facility. Residents interviewed report receiving medications as prescribed. Medication counts appear to be accurate in relation to MAR. At this time, LPAs find no credible evidence that staff failed to properly administer resident's medications. Medications appear to be given as prescribed. Therefore, the allegation is UNFOUNDED meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted with Administrator Rod Fleeman and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC9099 (FAS) - (06/04)

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