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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700212
Report Date: 01/04/2023
Date Signed: 01/04/2023 02:34:35 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2022 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20221028101128
FACILITY NAME:ROCK CREEK SENIOR CAREFACILITY NUMBER:
312700212
ADMINISTRATOR:BALINT, PAVELFACILITY TYPE:
740
ADDRESS:6408 MENDEZ CREEK CTTELEPHONE:
(916) 899-6298
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:6CENSUS: 4DATE:
01/04/2023
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Carmen Balint, Co-Administrator TIME COMPLETED:
02:35 PM
ALLEGATION(S):
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Facility locking residents in facility
Administrator Qualifications
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint investigation received on 10/28/2022. LPA met with Elenora Latu, and Sashauna Smith, caregivers, who contacted Administrator, Carmen Balint, who arrived at approximately 1:30 PM. LPA observed (1) resident to be in the common area and (3) residents to be napping or watching television in their rooms. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols and was wearing a surgical mask and was screened per Covid-19 precautionary measures upon entering the community.

During the course of the investigation, LPA interviewed Co-Administrator, Carmen, (1) Administrator Designee, (3) residents, hospice nurse and a family member of resident (R2). LPA also observed the locking mechanism on the sliding glass doors and on the kitchen drawer used for sharps. LPA reviewed documentation related to the 9-1-1 call made on 10/28/22, the approved fire clearance with facility sketch, and for residents (R1 and R2).

The investigation findings are as follows:

cont on 9099C(1)..
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
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 5
Control Number 25-AS-20221028101128
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: ROCK CREEK SENIOR CARE
FACILITY NUMBER: 312700212
VISIT DATE: 01/04/2023
NARRATIVE
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Allegation: Facility locking residents in facility. Complaint alleges that Fire Crew observed a dead bolt lock on the front door that required a key to open from the inside, locking residents in the facility.

LPA reviewed a report from local authorities, dated 10/28/22. which includes a photo taken of the inside of the front entrance door showing that a skeleton key type lock had been installed on the door frame and a photo of the key that was kept in a nearby drawer. On 10/28/22, LPA took photos of the facility front door showing a small hole on the right side of the door frame where an additional lock was installed. Administrator stated that she had just installed this additional lock because the door would not close properly.

On 12/15/22, LPA observed the hole on the door frame to have been filled and only (1) lock to be in place on the front door that is able to be unlocked from the inside without a key. LPA took a photo. Administrator stated to LPA on 12/15/22 that prior to receiving the facility license, the fire department approved the front entrance door as an entrance only and required (3) additional interior doors as well as (2) additional glass sliding doors to be installed to be in compliance with fire code. LPA observed exit signs posted above each glass sliding door (3) and also posted in each resident room indicating the exit route to be used to exit through the glass doors. LPA also observed an exit sign above the inside of the front entrance door.

On 12/15/22, LPA observed each glass sliding door to not have a locking mechanism in place and to be able to be opened easily. Administrator stated the doors have always had this specific non-locking mechanism. LPA interviewed resident (R1), who was awake during the early morning hours on 10/28/22 when 9-1-1 was called. R1 stated he has never had difficulty opening the glass sliding door in the common area from either the inside or outside patio area of the facility. There were no additional ambulatory residents able to be interviewed. Administrator Designee stated on 12/15/22 that the front entrance door at the facility is "always unlocked from the inside and always locked from the outside". The Administrator stated on 12/15/22 that the glass doors are "never locked" from the inside or outside and the doors have "always worked this way", asserting "the front door was "not considered an emergency exit" when fire issued their facility clearance during the licensing process. Fire clearance documentation shows the facility was approved for (6) non-ambulatory residents on 11-28-2017 and shows (4) designated or approved exits.

R1 stated to LPA that he is always able to open the glass door and it has "never been a problem", but he was not able to open the front door when 9-1-1 arrived on 10/28/22. LPA observed R1 to be able to ambulate without any assistive device.
cont on 90099C(2)..
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 25-AS-20221028101128
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: ROCK CREEK SENIOR CARE
FACILITY NUMBER: 312700212
VISIT DATE: 01/04/2023
NARRATIVE
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9099C(2)..Based on information obtained during the investigation that there were/are (3) additional designated unlocked exits, LPA finds the allegation to be UNFOUNDED- meaning that the allegations are false, could not have happened and/ or is without reasonable basis.

An Advisory Note is being issued today.


Allegation: Administrator Qualifications.

Regulation 87405 Administrator - Qualifications and Duties, was reviewed.

LPA confirmed that the Administrator of record, Pavel P. Balint, has been a certified Administrator since on/around 2016 and holds a current RCFE Administrator Certificate- # 6043137740 with an expiration date of 1/8/2023. Administrator, Carmen, stated the renewal paperwork was recently submitted to the Department. There is a second Administrator, Carmenuta "Carmen" D. Balint, who has a current RCFE Administrator certificate- #6036317740- exp 8/13/2023. Carmen indicated she has been a certified RCFE Administrator since on/around 2015.

LPA confirmed that Administrator has (3) current Administrator Designees in place. LPA spoke to one Designee on 12/15/22 when she arrived at the facility before Administrator arrived for the inspection.

Administrator stated she is aware of her responsibilities of being an Administrator, including but not limited to, complying with all licensing requirements and regulations and if she isn't sure, she will contact CCLD for additional guidance.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegations are false, could not have happened and/ or is without reasonable basis.

Exit interview. Copy of report provided to facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2022 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20221028101128

FACILITY NAME:ROCK CREEK SENIOR CAREFACILITY NUMBER:
312700212
ADMINISTRATOR:BALINT, PAVELFACILITY TYPE:
740
ADDRESS:6408 MENDEZ CREEK CTTELEPHONE:
(916) 899-6298
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:6CENSUS: 4DATE:
01/04/2023
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Carmen Pavel, TIME COMPLETED:
02:35 PM
ALLEGATION(S):
1
2
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Residents have access to sharp objects
INVESTIGATION FINDINGS:
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During the couse of the investigation, LPA interviewed the Co-Administrator, Administrator Designee, (3) residents and attempted to interview fire personnel. LPA also observed the locking mechanism on the kitchen drawer used for sharps. LPA reviewed police and fire documentation related to the 9-1-1 call made on 10/28/22 and documentation pertinent to residents (R1 and R2).

The results of the investigation are as follows:

R1 confirmed with LPA on 12/15/22 that he was in the kitchen at the time he was "waiting for 9-1-1" in the early morning hours of 10/28/22 and was hungry so he began to cut an apple. R1 was not able to identify exactly what kind of knife he was using, stating "it had some sharp to it, closer to a steak knife". R1 stated the knife was up on the counter and he is not allowed to use sharp knives but he has before and staff is aware that he has.


cont on 9099A-C(2)...




Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 25-AS-20221028101128
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: ROCK CREEK SENIOR CARE
FACILITY NUMBER: 312700212
VISIT DATE: 01/04/2023
NARRATIVE
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9099A-C(2).. LPA observed a kitchen drawer with both sharp knives and non-sharp or table knives to have a magnetic locking mechanism in place on 10/28/22 and on 12/15/22. LPA did not observe any sharp knives or other sharps to be unlocked in the kitchen or other areas of the facility during both inspections.

LPA reviewed R1's current physician's report, dated 8/2/22, which notes R1 has a diagnosis of Parkinson's Disease, muscle weakness, Pneumonitis, and cognitive communication deficit. The physician's report does not indicat that R1 has Mild Cognitive Impairment (MCI) or Dementia. Administrator stated that sometimes R1 is forgetful and confused. Administrator stated that residents will use a table knife only during meals.

LPA asked R1 if he can access sharp knives that are kept in a drawer in the kitchen. R1 stated he "doesn't know where everything is kept and if he did, he is not sure of what kind of locking system there is in place".

LPA reviewed a report dated 10/28/22 written by local authorities. The report notes resident (R1) "was standing in the kitchen using a knife to cut an apple" when 9-1-1 arrived at approximately 01:05 hours . The fire report for the same incident indicates that fire personnel took the knife away from R1 when he was observed to be using it to cut an apple and after he stated he wasn't "allowed to have a knife". The report does not specify what kind of knife R1 was using and LPA was unable to confirm this information with fire personnel.

R1 and Administrator stated R1 and resident R2 were the only ones awake when 9-1-1 was called on 10/28/22, while the local authorities report that there were (3) residents awake. R2 passed on/around November 2022 and was not able to be interviewed during a follow up inspection on 12/15/22. LPA was able to interview (1) additional resident (R3) who indicated he was asleep when 911 arrived and (1) other resident (R4) who stated the lights woke her up but she was unable to get out of bed.

Administrator stated that sharps are always locked up and she was at the facility until 11:00 pm on 10/27/22 and is certain there were no sharps or sharp knives left out in the kitchen unlocked.

Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that a complaint allegation 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. Copy of report left at facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5