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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700996
Report Date: 09/19/2023
Date Signed: 09/19/2023 02:27:34 PM

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
05/17/2023 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20230517113511
FACILITY NAME:WELLQUEST GRANITE BAY TENANTCO LLCFACILITY NUMBER:
312700996
ADMINISTRATOR:PARI MANOUCHEHRIFACILITY TYPE:
740
ADDRESS:9747 SIERRA COLLEGE BLVDTELEPHONE:
(916) 864-9800
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:135CENSUS: 114DATE:
09/19/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Pari ManouchehriTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff not properly trained
INVESTIGATION FINDINGS:
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LPA Parks arrived on Tuesday September 19, 2023, to conclude a complaint investigation regarding the above allegation.

LPA met with Administrator Pari and explained the purpose of the visit. Throughout the course of the investigation, LPA interviewed the Administrator, Health and Wellness Director, and reviewed training records for S1. The result of the investigation is as follows:

LPA reviewed S1 training records at the beginning of employment. Training records from Relias show a total of 33.65 hours including the following topics: Dementia, fire safety, first aid, RCFE medication policies and procedures, end of life care, and basic workplace safety. Specifically, the fire safety training reviews the following topics: escape routes, responding to fire, evacuation, and OSHA. The facility also produced training records showing that staff are trained quarterly regarding fire safety, evacuation, and using the evacuation stair chair. LPA discussed training policies for med techs with Desiree Thitphaneth
Unfounded
Estimated Days of Completion: 0
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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-20230517113511
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: WELLQUEST GRANITE BAY TENANTCO LLC
FACILITY NUMBER: 312700996
VISIT DATE: 09/19/2023
NARRATIVE
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Based on the staff schedule, S1 was training as a med tech for 3 days prior to working independently.

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 left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2