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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700831
Report Date: 09/26/2024
Date Signed: 09/26/2024 04:39:46 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
09/24/2024 and conducted by Evaluator Tung Truong
COMPLAINT CONTROL NUMBER: 27-AS-20240924091244
FACILITY NAME:HONEST LIVINGFACILITY NUMBER:
342700831
ADMINISTRATOR:TRAN, VINHFACILITY TYPE:
740
ADDRESS:9449 CHEVERNY WAYTELEPHONE:
(916) 425-8161
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:6CENSUS: 4DATE:
09/26/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Vinh Tran - AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff are not responding to resident's call button in a timely manner
Staff left resident in soiled diapers for extended period of time
INVESTIGATION FINDINGS:
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On 9/26/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to commence a complaint investigation with the allegations mentioned above. LPA met with Administrator Vinh Tran and explained the purpose of the visit.

During today’s visit, LPA conducted interviews and reviewed records. Based on records review, and staff and resident interviews, there is not a preponderance of evidence to substantiate the allegations mentioned above. Regarding the allegation, “Staff are not responding to resident's call button in a timely manner” LPA obtained the following information through interviews. resident (R1) stated that staff response to call pendant anywhere from 15 -30 minutes on multiple occasions. Interviews conducted did not reveal any corroborated statements of staff not responding to resident's call button in a timely manner. Staff (S1) stated that resident is tended to within 3-5 minutes when resident call for help.

Regarding the allegation, “Staff left resident in soiled diapers for extended period of time” LPA obtained the following information through interviews. There is insufficient evidence indicating that resident (R1) was left soiled for an extended period of time.

Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
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-20240924091244
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: HONEST LIVING
FACILITY NUMBER: 342700831
VISIT DATE: 09/26/2024
NARRATIVE
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 According to staff, R1 is turns and has diaper change every two hours. Staff stated that R1 doesn’t want to be disturbed after 11:30 pm unless resident calls for help. According to home health nurse, R1’s skin rash around the groin area is improving from a stage 2 to a stage 1. Based on statement obtained, there is no indication that staff left resident soiled for an extended period of time. Facility staff and home health nurse stated that R1 is very challenging and demanding. Staff stated that R1 is never satisfied with care. According to interviews and records review, R1 has a history of noncompliance and frequently yelling at staff.

As a result of the investigation, LPA finds the allegations above to be UNSUBSTANTIATED- A finding 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 and a copy of the report was provided upon exit.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2