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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701251
Report Date: 10/24/2024
Date Signed: 10/24/2024 01:15:25 PM

Substantiated


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
09/16/2024 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240916172545
FACILITY NAME:APPLE RIDGE ASSISTED LIVING, LLCFACILITY NUMBER:
342701251
ADMINISTRATOR:KHODORKOVSKY, AARONFACILITY TYPE:
740
ADDRESS:3950 ANNADALE LANETELEPHONE:
(916) 489-6900
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:94CENSUS: 83DATE:
10/24/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Alfredo Cruz TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Staff left residents in a soiled diaper for a long period of time
Staff did not shower residents in care

INVESTIGATION FINDINGS:
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On 10/24/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Alfredo Cruz and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegation above.
Current census was 83. A brief interview with FDA Cruz was conducted.

Staff left residents in a soiled diaper for a long period of time
It was alleged that facility staff did not meet resident’s incontinence care needs. During this investigation, the LPA reviewed facility documentation and conducted interviews with both staff and residents.
Interviews with 9 staff members revealed that 5 believe they can adequately address residents' incontinence care needs, yet they have observed that some colleagues on certain shifts fail to provide this care. These staff members reported instances where they found residents soiled in urine, with messes extending from incontinence pads onto bedding at the start of their shifts. 4 staff members denied any inability to assist with incontinence care.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
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 5
Control Number 27-AS-20240916172545
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: APPLE RIDGE ASSISTED LIVING, LLC
FACILITY NUMBER: 342701251
VISIT DATE: 10/24/2024
NARRATIVE
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Interviews with 9 residents indicated that all require assistance with incontinence care and showering. 7 out 9 residents reported being left in soiled incontinence briefs for approximately three to seven hours, stating that staff are aware of their condition but do not provide the necessary assistance.

In addition, LPA Pascua conducted 3 unannounced visits on 07/16/2024 at 1:30pm to 5:00pm, 09/19/2024 at 10:00am-5:00pm, and 10/18/2024 at 6:30am-11:00am. During these visits, LPA Pascua observed a strong urine smell in consistently detected in hallways 2 and 3.

Based on interviews and record review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met.


This deficiency is addressed on the complaint investigation dated 10/24/2024 and a plan of correction has been established. Therefore, there will not be a 9099D page for this substantiated finding.

Allegation: Facility staff did not provide showers

It was alleged that staff did not shower residents in care. During the course of this investigation, this LPA reviewed facility documentation, and conducted staff and resident interviews. Interviews were conducted with 9 staff members, 5 of 9 who reported that they provide showers for residents. However, they noted instances where other staff claimed to have given showers or attempted to do so, but the shower logs indicated that residents had refused. Additionally, 5 staff members mentioned that many residents often complain about not having received a shower in the past week or are unsure of when their last shower took place.

In a separate interview with 9 residents, 7 reported that they do not receive regular showers, averaging only 2 showers per month. In contrast, 2 residents stated that they do not have any issues accessing showers. The LPA also reviewed the facility’s AM and PM shower schedule, which showed that residents are scheduled for full showers two to three times a week. Based on the information gathered, the staff did not shower residents in care.

Based on interviews and record review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met.


This deficiency is addressed on the complaint investigation dated 10/24/2024 and a plan of correction has been established. Therefore, there will not be a 9099D page for this substantiated finding.An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20240916172545
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: APPLE RIDGE ASSISTED LIVING, LLC
FACILITY NUMBER: 342701251
VISIT DATE: 10/24/2024
NARRATIVE
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This deficiency is addressed on the complaint investigation dated 10/24/2024 and a plan of correction has been established. Therefore, there will not be a 9099D page for this substantiated finding.

An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
09/16/2024 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240916172545

FACILITY NAME:APPLE RIDGE ASSISTED LIVING, LLCFACILITY NUMBER:
342701251
ADMINISTRATOR:KHODORKOVSKY, AARONFACILITY TYPE:
740
ADDRESS:3950 ANNADALE LANETELEPHONE:
(916) 489-6900
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:94CENSUS: 83DATE:
10/24/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Alfredo Cruz TIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not ensure that the air conditioning system was repaired
Staff did not ensure that residents are fed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/24/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Alfredo Cruz and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegation above.
Current census was 83. A brief interview with FDA Cruz was conducted.
Allegation: Facility did not ensure that the air conditioning system was repaired
It was alleged that the facility air conditioning is in disrepair. During the course of this investigation, this LPA reviewed facility documentation and conducted staff and resident interviews. Interviews revealed that on May 31, 2024, the air conditioning unit in Hallway 3 was functioning intermittently. By June 3, the staff discovered that the AC system had completely failed. On the same day, the facility contacted multiple vendors to assess the situation and confirmed the complete failure of the AC unit. A down payment of $10,000 was made for a new system, and the facility purchased nine portable AC units from Home Depot to install in the bedrooms of Hallway 3. Temperature checks were conducted to ensure compliance with regulatory standards.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20240916172545
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: APPLE RIDGE ASSISTED LIVING, LLC
FACILITY NUMBER: 342701251
VISIT DATE: 10/24/2024
NARRATIVE
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On June 24, 2024, the new AC unit was delivered and installed by the vendor, with confirmation that it was operational. The final invoice for the AC unit was paid on July 8, 2024. Interviews with nine residents confirmed that the air conditioning had been fixed and that portable units were provided while the main system was down. Three of the nine residents noted some discomfort but found it manageable with the portable units, while six reported no issues at all.

A review of invoices from Wallace Heating and Air and Home Depot confirmed the purchase and installation dates of the new AC unit. The facility's Temperature Log showed that from July 2024 to the present, the temperatures in resident bedrooms remained between 71-75 degrees. Additionally, temperature readings taken in ten resident bedrooms indicated temperatures between 70-74 degrees.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

Allegation: Staff did not ensure that residents are fed

It was alleged that staff did not ensure that the resident’s are fed. During the course of this investigation, this LPA reviewed facility documentation, conducted observations, and conducted staff and resident interviews. Based on interviewed conducted with 9 staff. All 9 staff members report that they provide meals to residents in their rooms if they prefer not to eat in the dining room. Additionally, snacks are available to residents between meals. None of the staff indicated that residents go unfed. Interviews with 9 residents revealed that all deny not being fed. Five residents expressed a preference for having their meals delivered to their rooms, while four prefer eating in the dining room. All residents reported that their food is served on time. They also confirmed that they can request snacks or access food between meals. During three unannounced visits on 07/16/2024, 09/19/2024, and 10/18/2024, the LPA observed that snacks and food were readily available. Furthermore, the facility has established a café area that residents can access at any time. Based on the information gathered it is unclear if the staff did not ensure that residents are fed.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5