315920092-1-21-2025-59-AS-LMUZ-DD733D-20250122165322

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315920092
Report Date: 01/21/2025
Date Signed: 01/21/2025 12:46:40 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
11/22/2024 and conducted by Evaluator Cassandra Mikkelson

COMPLAINT CONTROL NUMBER: 59-AS-20241122162534

FACILITY NAME:	SAKURA HOME CARE		FACILITY NUMBER:	315920092
ADMINISTRATOR:	MALITSKIY, JULIE		FACILITY TYPE:	740
ADDRESS:	1220 HORTON LN		TELEPHONE:	(279) 900-8464
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	6	CENSUS: 5	DATE:	01/21/2025
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Julie Malitskiy, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility staff did not assist residents with care needs.

INVESTIGATION FINDINGS:

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Licensed Program Analysts (LPAs) Cassandra Mikkelson and Michael Hood arrived at the facility unannounced and met with Julie Malitskiy to deliver findings for the above complaint allegation.

During the investigation, LPAs conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

** Report continued on 9099-C **

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20241122162534

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: SAKURA HOME CARE	FACILITY NUMBER: 315920092
	VISIT DATE: 01/21/2025

NARRATIVE

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Interviews conducted with staff members S1, S2, and Administrator indicated that staff are providing residents with assistance showering once to twice a week. During subsequent visit, interview with R2 confirmed that staff were providing assistance with two (2) showers a week. S1, S2, and Administrator stated that care staff provide bed baths daily for the residents needing incontinence care. S1, S2, and Administrator stated that care staff are providing assistance with incontinence care for the residents, including assistance with residents' catheters and transfer assistance to the toilet for R1.

During multiple visits conducted at the facility, LPAs observed daily bed baths are documented as given daily for residents R1 and R2. LPAs did not observe showers documented in facility progress notes. Interview with Administrator indicated that R1 and R2 have no cognitive impairment and can request additional showers if wanted. LPAs observed R1 and R2's documentation, which indicates that neither have cognitive impairment and both are able to communicate their own needs.

Interview with S1 indicated that R2's physical therapist and Administrator provide assistance with walking. Interview with Administrator indicated that they assist with R2 walking three (3) or four (4) times a week. Interview with R2 indicated that Administrator is helping them ambulate throughout the facility. During subsequent visit, R2 stated that care staff were now providing assistance with walking around the facility.

Interviews with R1 and R2 stated that they are satisfied with the care being received at the facility by the care staff. R1 stated that they receive assistance with showering and hygiene, toileting and walking in the facility. R2 stated that they received assistance with showering, hygiene and walking in the facility. R1 and R2 stated that they receive bed baths daily and showering one (1) shower weekly.

Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. Findings 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 was conducted with Julie Malitskiy. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025

LIC9099 (FAS) - (06/04)

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