342700678-3-17-2023-25-AS-KHOS-CQDJXG-20230329072618

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700678
Report Date: 03/17/2023
Date Signed: 03/17/2023 01:27:28 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, 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
11/03/2022 and conducted by Evaluator Cassie Yang

COMPLAINT CONTROL NUMBER: 25-AS-20221103162040

FACILITY NAME:	LOVING CARE SENIOR LIVING II		FACILITY NUMBER:	342700678
ADMINISTRATOR:	RONSTADT, STEVEN		FACILITY TYPE:	740
ADDRESS:	4021 FAIRWOOD WAY		TELEPHONE:	(916) 944-4969
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 6	DATE:	03/17/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Kelly Conley		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility is not allowing residents to have visitors
Residents' oral care needs are not being met
Facility is supervising residents' visits

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cassie Yang arrived at the facility unannounced to deliver the findings of the allegations cited above. LPA met with House Manager, Kelly Conley, and with Administartor, Steven Ronstadt via phone, and explained the purpose of the visit. During today's visit, LPA worn the following Personal Protective Equipment: surgical mask. Additionally, LPA was screened upon entry.

During this investigation, the Department had conducted records review and extensive interviews. Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation 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.

Please see LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023

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 25-AS-20221103162040

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: LOVING CARE SENIOR LIVING II	FACILITY NUMBER: 342700678
	VISIT DATE: 03/17/2023

NARRATIVE

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Continue LIC 9099...

Allegation- Facility is not allowing residents to have visitors.
The department conducted interviews regarding this allegation. A review of documentation and interviews conducted revealed that there is a court order in place regarding R1's visitations. Facility had notified Licensing and Responsible Party regarding concerns for R1's health and safety during visitations which resulted to televised visitation instructed by conservator. Based on interview, R1's visitations were to remain televised until further notice from conservator as documentation revealed conservator had rights to. Therefore this allegation is UNSUBSTANIATED . A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

Allegation- Residents' oral care needs are not being met.
The department conducted records review regarding this allegation. A review of documentation dated on 11-11-2022 revealed medical professional addressed in visit was completed on 7-27-2022 and 10-20-2022 there was no concerns of R1's oral care as R1's teeth were chipped but in good oral hygiene. Therefore this allegation is UNSUBSTANIATED . A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

Allegation- Facility is supervising residents' visits.
The department conducted interviews regarding this allegation. A review of documentation and interviews conducted revealed that after an incident took place during previous visitation, facility was ordered by conservator to moved visitations from private setting to the common area to ensure the health and safety of resident in care. A file review conducted revealed documentation which granted conservator to have rights on visitations as conservator deemed fit. Therefore this allegation is UNSUBSTANIATED . A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted and a copy of this report was provided to the facility.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023

LIC9099 (FAS) - (06/04)

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