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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920037
Report Date: 05/09/2024
Date Signed: 05/09/2024 02:05:02 PM

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
03/26/2024 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20240326134435
FACILITY NAME:SAPPHIRE SENIOR CAREFACILITY NUMBER:
315920037
ADMINISTRATOR:TULENINOVA, NATALIAFACILITY TYPE:
740
ADDRESS:667 GRIDER DRIVETELEPHONE:
(916) 257-4525
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 3DATE:
05/09/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Natalia TuleninovaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff yells at resident in care.
INVESTIGATION FINDINGS:
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On 5/9/24, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Administrator.

LPA conducted records review and extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.

It was alleged that staff were hear to yell and swear at R1 in two different occasions while R1 was outside on the facility property with staff. R1’s records indicate that R1 is wheelchair dependent and has memory loss due to cognitive decline. When interviewed by LPA, R1 stated on multiple occasions that R1 does not go outside and that staff treat R1 respectfully. R1 stated that R prefers to stay in bed and that staff meet R1’s care needs.
Interviews with staff also found that R1 rarely wishes to leave R1’s room despite staff encouragement to do so. Staff interviewed stated that they had not witnessed R1 being mistreated.
Interviews with other residents of the home found they had not observed R1 to go outside the house nor that staff were ever heard to yell at or insult R1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
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 2
Control Number 59-AS-20240326134435
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: SAPPHIRE SENIOR CARE
FACILITY NUMBER: 315920037
VISIT DATE: 05/09/2024
NARRATIVE
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LPA attempted to interview the neighbor adjacent to the house and left a business card for a call back. Neighbor did not respond to LPA attempts.

As a result of this investigation, LPA finds allegation to be (US)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 with administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2