097005554-12-10-2024-59-AS-LMUZ-DBUNRJ-20241211094134

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 097005554
Report Date: 12/10/2024
Date Signed: 12/10/2024 10:00:27 AM

Unsubstantiated

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
08/20/2024 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20240820142014

FACILITY NAME:	EL DORADO HILLS SENIOR CARE		FACILITY NUMBER:	097005554
ADMINISTRATOR:	DR. BENJAMIN FOULK		FACILITY TYPE:	740
ADDRESS:	2904 TAM O'SHANTER DRIVE		TELEPHONE:	(916) 933-0107
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	6	CENSUS: 0	DATE:	12/10/2024
		UNANNOUNCED	TIME BEGAN:	09:51 AM
MET WITH:	RCC Serge Entona		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff are smoking illegal drugs on the premises

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024

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 3

Control Number 59-AS-20240820142014

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: EL DORADO HILLS SENIOR CARE	FACILITY NUMBER: 097005554
	VISIT DATE: 12/10/2024

NARRATIVE

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Staff are smoking illegal drugs on the premises
Witness stated that S1 and S2 smoke methamphetamine on the facility premises. Witness stated that the last time drug use was witnessed was in June or July of 2024. Administrator and Licensee were interviewed and stated that S1’s ex and witness has not worked at the facility for over four to five years. Their statements contradict witness claims. S1 was interviewed and stated that witness has made similar allegations of drug use to Placer County Child Protective Services (CPS). S1 adamantly denied ever using illegal drugs at the facility and claimed to have passed routine drug screenings with CPS in July of 2024. Placer County Social Worker confirmed that S1 passed all three tests in July. S2 denied using illegal drugs at the facility. S2 stated that S2 uses marijuana on S2’s off-time; however, S2 stated S2 has never been high at work. Staff and residents were interviewed and denied ever seeing S1 or S2 smoking drugs, or tobacco products, on the facility premises, therefore the allegation is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted. Report left with RCC.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
08/20/2024 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20240820142014

FACILITY NAME:	EL DORADO HILLS SENIOR CARE		FACILITY NUMBER:	097005554
ADMINISTRATOR:	DR. BENJAMIN FOULK		FACILITY TYPE:	740
ADDRESS:	2904 TAM O'SHANTER DRIVE		TELEPHONE:	(916) 933-0107
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	6	CENSUS: 0	DATE:	12/10/2024
		UNANNOUNCED	TIME BEGAN:	09:51 AM
MET WITH:	RCC Serge Entona		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff is stealing residents medications

INVESTIGATION FINDINGS:

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On 12/10/24, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with RCC Serge Entona.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.The results of the investigation are as follows:

Based on record reviewed, interview with Administrator, and facility observation, the facility has not been operating since February/March of 2024 due to cosmetic remodeling. The facility had no residents, or medications, in the facility home at the time of the complaint, therefore the 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 conducted. Report left with RCC.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3