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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700852
Report Date: 07/18/2023
Date Signed: 08/08/2023 11:16:50 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, 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
07/05/2023 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20230705092044
FACILITY NAME:LAKESIDE SENIOR LIVING OF GRANITE BAY, LLCFACILITY NUMBER:
312700852
ADMINISTRATOR:LORDACHE-STIR, ADRIANAFACILITY TYPE:
740
ADDRESS:8365 BARTON RDTELEPHONE:
(916) 205-2273
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:6CENSUS: 6DATE:
07/18/2023
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Adriana Lordache-StirTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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-Staff is financially abusing resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived unannounced on July 18, 2023, to complete and deliver findings to a complaint received on 7/5/2023. LPA met with caregiver and explained the purpose of the visit. LPA spoke with Administrator, Adriana, by phone. Administrator indicated that caregiver can sign report.

Throughout the course of the investigation, LPA Parks interviewed the Administrator and R1. LPA Parks reviewed R1’s banking transaction history with the Administrator and the Ombudsman. LPA Parks learned that R1 moved into this facility on 2/2/2023. Prior, R1 lived at another residential facility in Rocklin. While at the previous facility, the owner held possession of R1’s banking card. Fraudulent charges began on 2/8/2023, showing repeated charges including rideshare companies and restaurants. These transactions began from 2/8/2023 – 7/3/2023 until the current Administrator noticed fraudulent changes and notified R1’s banking institution.
***************************************Continued on LIC9099C*************************************************
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
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 2
Control Number 59-AS-20230705092044
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: LAKESIDE SENIOR LIVING OF GRANITE BAY, LLC
FACILITY NUMBER: 312700852
VISIT DATE: 07/18/2023
NARRATIVE
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The fraudulent charges totaled $4,577.73. Due to these charges, R1 was unable to make their rent requirement of $1,100 per month at their current facility. LPA Parks was able to verify that these fraudulent charges were not done by any staff at R1’s current facility. The Administrator has since filed a police report due to the fraudulent charges. A complaint will be drafted for R1’s previous facility regarding staff financially abusing a resident.

Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegation is found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. A copy of this report was provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2