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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701168
Report Date: 09/24/2024
Date Signed: 09/24/2024 03:41:10 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
07/10/2024 and conducted by Evaluator Tung Truong
COMPLAINT CONTROL NUMBER: 27-AS-20240710103529
FACILITY NAME:YOUNG AT HEART RCFE NO.3 INCFACILITY NUMBER:
342701168
ADMINISTRATOR:SISAYAN, LILLIANFACILITY TYPE:
740
ADDRESS:9375 BROWNSBERG WAYTELEPHONE:
(916) 681-3689
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:6CENSUS: 6DATE:
09/24/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Lianna SisayanTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff leaves resident soiled for an extended period of time resulting in resident developing a UTI.
Staff is misusing resident's personal belongings.
INVESTIGATION FINDINGS:
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On 9/24/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to complete and deliver the findings for a complaint investigation with the allegations above. LPA met with facility staff Glenda Molinyawe and explained the purpose of the visit. Administrator Lianna Sisayan arrived a bit later.

Throughout the course of the investigation, LPA conducted interviews and reviewed records. Based on records review, and staff and resident interviews, there is insufficient evidence to substantiate the allegations mentioned above. Regarding the allegation, “Staff leaves resident soiled for an extended period of time resulting in resident developing a UTI” LPA obtained the following information through interviews. Based on resident interviews, 2 out 4 indicated their diapers were not changed timely. Based on records review, there is insufficient evidence indicating that resident (R1) was left soiled for an extended period of time resulting in resident developing a urinary tract infection (UTI). R1 was admitted the hospital on 6/30/24 and 7/4/2024 and was diagnosed with Hematuria. LPA was unable to get a statement from R1 or R1’s responsibly party for further information.

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

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
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-20240710103529
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: YOUNG AT HEART RCFE NO.3 INC
FACILITY NUMBER: 342701168
VISIT DATE: 09/24/2024
NARRATIVE
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Regarding the allegation, “Staff is misusing resident’s personal belongings” LPA obtained the following information through interviews. Based on staff interviews, residents all have their own supplies and were not being given to the other residents. Interviews conducted did not reveal any corroborated statements of staff is misusing resident’s personal belongings.

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: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2