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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701307
Report Date: 08/25/2023
Date Signed: 08/25/2023 01:28:15 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/23/2023 and conducted by Evaluator Victoria Brown
COMPLAINT CONTROL NUMBER: 27-AS-20230823135722
FACILITY NAME:MACERO ELDER CARE, LLCFACILITY NUMBER:
342701307
ADMINISTRATOR:DORIS ESPINOZAFACILITY TYPE:
740
ADDRESS:760 EL MACERO WAYTELEPHONE:
(916) 476-3830
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:6CENSUS: 6DATE:
08/25/2023
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Doris EspinozaTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff do not provide residents individual privacy in all toilet, bath and shower areas
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct an investigation of the above mentioned allegation on 8/25/23 at 8:30am. LPA met with Doris Espinoza, Administrator and stated the purpose of the visit. LPA and Administrator conducted a tour of the home to observe the handles and entrances of the bathroom doors. There are 3 bathrooms and 6 bedrooms in the home. Each room is used as a private room. There is 1 bathroom in one of the rooms, 1 used for showers and 1 used for toileting only which has a door to one of the private rooms. This bathroom has two doors, one toward the resident room and one toward the dining room. LPA conducted interviews of staff, resident #1 (R1), Administrator, and responsible parties.

The Administrator was not aware of any privacy issue that happened recently.

See 9099C for continuation...
Substantiated
Estimated Days of Completion: 30
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
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 3
Control Number 27-AS-20230823135722
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: MACERO ELDER CARE, LLC
FACILITY NUMBER: 342701307
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/01/2023
Section Cited
CCR
87307(c)
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Personal Accommodations and Services
Individual privacy shall be provided in all toilet, bath and shower areas.
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Licensee/Administrator shall change the door knobs of the bathrooms to one that can lock providing privacy to a residents and/or visitors and staff.
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This requirement is not met as evidenced by: Based on interviews, R1 was not provided privacy in bathroom on several occassions where as staff would open the door without knocking first.
This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20230823135722
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: MACERO ELDER CARE, LLC
FACILITY NUMBER: 342701307
VISIT DATE: 08/25/2023
NARRATIVE
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9099 continued...

The investigation revealed that a sign was posted sometime in June by the Administrator stating "Please knock Thank you" on the bathroom between R1's room and the dining area.

Although the sign was posted for others to knock before entering, the sign was ignored on some occasions. This lead to unauthorized entry, violating R1's right to privacy.

There is not a preponderance of evidence that this has happened recently, however, LPA obtained information that this has been witnessed several times during the month of June.

R1 concur that this occurred and is not being followed which is the reason the sign was put on the door.


The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Per California Code of Regulations (CCRs) - Title 22, Div.6, Ch. 8, deficiencies are being cited on the attached 9099D during this visit.

If any deficiencies are not corrected by the noted due dates; civil penalties may be assessed. A copy of their rights was provided (LIC9058) and their signature on this form acknowledges receipt of these rights.

An exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3