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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701170
Report Date: 11/08/2023
Date Signed: 11/08/2023 11:17:13 AM

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
09/11/2023 and conducted by Evaluator Jamie Ivey-Canady
COMPLAINT CONTROL NUMBER: 27-AS-20230911150119
FACILITY NAME:YOUNG AT HEART RCFE NO.4 INCFACILITY NUMBER:
342701170
ADMINISTRATOR:SISAYAN, LILLIANFACILITY TYPE:
740
ADDRESS:9012 COLOMBARD WAYTELEPHONE:
(916) 682-6080
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:6CENSUS: 4DATE:
11/08/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Glenda MolinyaweTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Resident was inappropriately touched by staff in a sexual manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)s Jamie Ivey Canady arrived at the facility unannounced to deliver complaint investigation findings. LPA Ivey Canady explained the purpose of the visit and was met by Glenda Molinyawe.

The investigation was conducted by the Department. The investigation consisted of resident medical and file review, in addition to facility incident reports and file review.

The Department has determined the following as it relates to the allegations: Resident was inappropriately touched by staff in a sexual manner.


Continued on LIC 9099 - C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Jamie Ivey-Canady
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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 2
Control Number 27-AS-20230911150119
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.4 INC
FACILITY NUMBER: 342701170
VISIT DATE: 11/08/2023
NARRATIVE
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On 11/06/2023 LPA Ivey Canady reviewed Department findings regarding current allegations. The Department findings are based on staff, resident and witness interviews as well as facility and medical file documents. Based on facility file documents dated 9/12/2023, R1 was admitted to the hospital on 09/08/2023. According to witness statements, medical documentation and medical file review, R1 has a history of dementia. On 9/12/2023, the Department received a report of possible abuse to R1 from the facility. On 9/08/2023 the facility contacted the Sacramento County Sheriffs Office and made a report of possible abuse to R1. On 9/14/2023 RP contacted the Department to recant current facility allegations. According to facility physician’s report dated 7/25/2023 R1 has a diagnosis of dementia and is listed as nonambulatory with both a physical and mental condition. According to witness statements, medical file documents and facility staff interviews, it was learned that R1’s family history and medical diagnosis include bi-polar and schizophrenia diagnosis. Based on facility staff interviews, and facility file review, R1’s incontinence care has been performed by a skilled and trained staff with no history of abuse and no abuse has been imparted on R1. Based on interviews, file reviews to include physician reports and behavior intervention plans, the Department has deemed the allegation Resident was inappropriately touched by staff in a sexual manner to be Unsubstantiated.

An unsubstantiated finding means 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, therefore the allegation is UNSUBSTANTIATED.


Per California Code of Regulations (CCRs) - Title 22, no deficiencies cited. Exit interview was held and a copy of report was given to Administrator Glenda Molinyawe.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Jamie Ivey-Canady
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
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