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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700458
Report Date: 02/23/2024
Date Signed: 02/23/2024 03:17:30 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
02/21/2024 and conducted by Evaluator Kevin Gould
COMPLAINT CONTROL NUMBER: 27-AS-20240221133222
FACILITY NAME:MUIRFIELD A HOME FOR THE ELDERLYFACILITY NUMBER:
342700458
ADMINISTRATOR:LOBO, ANALIZAFACILITY TYPE:
740
ADDRESS:7541 MUIRFIELD WAYTELEPHONE:
(916) 424-4553
CITY:SACRAMENTOSTATE: CAZIP CODE:
95822
CAPACITY:6CENSUS: 6DATE:
02/23/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Marilyn CarpioTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights: Staff hit resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced complaint inspection at Muirfield A Home for the Elderly on 2/23/24 at 1:30pm to inform the licensee of complaint allegation mentioned above.

During this investigation LPA Gould interviewed S1, R1, R2 and R3 (See confidential name list LIC-811 dated 2/23/24). Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated because All residents interviewed denied the allegations including the identified alleged victim. All statements obtained indicate that staff were attempting to wake resident who was making a disturbance in their sleep. Resident states she now understand staff were attempting to wake her and is what they also informed the police when they responded to the home.

Report Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
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 27-AS-20240221133222
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MUIRFIELD A HOME FOR THE ELDERLY
FACILITY NUMBER: 342700458
VISIT DATE: 02/23/2024
NARRATIVE
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9
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19
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21
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26
27
28
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31
32
Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Personal Rights are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies noted or cited per California Code Regulation, TITLE 22

Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2