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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700570
Report Date: 07/05/2023
Date Signed: 07/05/2023 10:04:23 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/29/2023 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230329164139
FACILITY NAME:SEN'S CAREGIVINGFACILITY NUMBER:
342700570
ADMINISTRATOR:PRASAD, INDRA SENFACILITY TYPE:
740
ADDRESS:5250 SHORTWAY DRTELEPHONE:
(916) 471-9145
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:6CENSUS: 3DATE:
07/05/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Ekshay ShahilTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Licensee neglect resulted in unexplained burns to resident.
INVESTIGATION FINDINGS:
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On 07/05/2023 at 9:45 AM, Licensing Programs (LPAs) Avelina Martinez and Pang Lee arrived at the facility unannounced to deliver complaint findings. LPA Martinez met with Ekshay Shahil during today’s visit and explained the purpose of today’s visit.

Throughout the course of this investigation, the Department conducted facility record reviews and conducted interviews. The investigation revealed R1 was dressed by facility staff on the morning of March 25, 2023. Facility staff 1 (S1) reported no burn injuries were found on R1 during the March 25, 2023 morning clothing change. In addition, facility staff 2 (S2) reported they did not observed any injuries on R1 on the morning of March 25, 2023. Furthermore, on this day, witness 2 (W2) picked up R1 from the facility in the morning and reported they did not observe any burn injuries. R1 was out of the facility for several hours on March 25, 2023. At around 2200 hours, R1's clothes were changed by facility staff. At this time, R1 had burn injuries on their body. Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/29/2023 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230329164139

FACILITY NAME:SEN'S CAREGIVINGFACILITY NUMBER:
342700570
ADMINISTRATOR:PRASAD, INDRA SENFACILITY TYPE:
740
ADDRESS:5250 SHORTWAY DRTELEPHONE:
(916) 471-9145
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:6CENSUS: 3DATE:
07/05/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Ekshay ShahilTIME COMPLETED:
10:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek medical attention for resident’s injuries
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
On 07/05/2023 at 9:45 AM, Licensing Program Analysts (LPAs) Avelina Martinez and Pang Lee arrived at the facility unannounced to deliver complaint findings. LPA Martinez met with Ekshay Shahil during today’s visit and explained the purpose of today’s visit.

Throughout the course of this investigation, the Department conducted facility record reviews and conducted interviews. The investigation revealed facility staff notice R1 had a burn injury, and reported the injury to R1's authorized representative. It was also learned R1' authorized representative refused to send R1 to the emergency room. R1's authorized representative scheduled an appointment with R1's primary care physician on March 28, 2023. As a result, facility staff did seek medical attention for R1 burn injuries in a timely manner.

Continued....
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20230329164139
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: SEN'S CAREGIVING
FACILITY NUMBER: 342700570
VISIT DATE: 07/05/2023
NARRATIVE
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This agency has investigated the complaint alleging (Staff did not seek medical attention for resident’s injuries). We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20230329164139
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: SEN'S CAREGIVING
FACILITY NUMBER: 342700570
VISIT DATE: 07/05/2023
NARRATIVE
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Moreover, R1 was not able to articulate how they got their injuries. The investigation findings determined it is unknown at what time R1 got the injuries; where are R1 sustained the injuries, and how R1 sustained their injuries. As a result, Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4