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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700369
Report Date: 11/02/2023
Date Signed: 11/02/2023 09:33:51 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/20/2023 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230920101802
FACILITY NAME:COMMONS AT ELK GROVE, THEFACILITY NUMBER:
342700369
ADMINISTRATOR:MEGGIN CORTEZFACILITY TYPE:
740
ADDRESS:9564 SABRINA LANETELEPHONE:
(916) 683-6833
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:110CENSUS: 90DATE:
11/02/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Meggin CortezTIME COMPLETED:
09:40 AM
ALLEGATION(S):
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Staff do not ensure medications are properly managed for residents in care
Staff do not ensure medication records are maintained for residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Meggin Cortez and explained the purpose of the visit.

This investigation consisted of interviews, record review and observation.

LPA Moleski reviewed medication administration records (MARs) for July, August, and September for 10 residents (R1-R10). LPA Moleski did not observe on any of these MARs for any of these residents any instances where medications ran out and were not given as a result. LPA Moleski observed no irregularities on these MARs that were not explained in marginal notes on these MARs.

[continued on 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
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 27-AS-20230920101802
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: COMMONS AT ELK GROVE, THE
FACILITY NUMBER: 342700369
VISIT DATE: 11/02/2023
NARRATIVE
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LPA Moleski observed staff count out all centrally stored narcotics stored on two medication carts on October 2, 2023. LPA Moleski observed an accurate count of the narcotics, and reviewed narcotic administration records which reflected the count of narcotics accurately.

LPA Moleski interviewed eight residents (R2, R11-R17) and 11 staff members (S1-S11). None of the residents or staff members interviewed expressed any issues with running out of medications, or being unable to order new medications. None of the staff members interviewed were aware of any irregularities with regard to the facility’s narcotic count.

The department has determined the following as it relates to the allegations that staff do not ensure medications are properly managed for residents in care and that staff do not ensure medication records are maintained for residents in care:

Based on observation, record review, and interviews, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was left with Cortez.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2