345002823-12-4-2024-59-AS-APEZ-DC3P27-20241218095524

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002823
Report Date: 12/04/2024
Date Signed: 12/04/2024 02:10:44 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
09/18/2024 and conducted by Evaluator Michael Hood

COMPLAINT CONTROL NUMBER: 59-AS-20240918155401

FACILITY NAME:	WHOLESOME ELDERLY ON KIFISIA		FACILITY NUMBER:	345002823
ADMINISTRATOR:	FAAMAUSILI,CHRIS		FACILITY TYPE:	740
ADDRESS:	6024 KIFISIA WAY		TELEPHONE:	(916) 678-0268
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	6	CENSUS: 6	DATE:	12/04/2024
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Juan Ramirez, Administrator		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Staff sexually abused resident

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Michael Hood and Cassie Mikkelson arrived at the facility and met with Administrator, Juan Ramirez, to deliver findings into the complaint allegation listed above.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

Allegation: Staff sexually abused resident

** Report continued on 9099-C **

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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 3

Control Number 59-AS-20240918155401

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: WHOLESOME ELDERLY ON KIFISIA	FACILITY NUMBER: 345002823
	VISIT DATE: 12/04/2024

NARRATIVE

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The Department received a report that staff member (S1) was sexually inappropriate with resident (R1) when S1 exposed themselves to R1. R1 was interviewed by the Department, LPA Michael Hood, and the Sacramento County Sheriff's Office and, in each interview, R1 provided inconsistent statements related to where the exposure happened. R1 has Alzheimer's Disease and was unable to provide additional information or details related to the allegation regarding sexual abuse other than S1 had exposed themselves to R1 on one occasion.

Staff members (S2 and S3) were interviewed and stated that R1 has had abnormal interactions with males who come into the facility. R1 has been known to insert themselves into conversations with males and has been seen removing their clothing upon males entering the facility. Additionally, S2, S3, and R1's Power of Attorney reported that R1 had been messaging males online, discussing them picking R1 up from the facility, and possibly having romantic relationships. Staff mentioned R1 would often ask residents inappropriate personal questions about hygiene and needed to be redirected. R1 has also been known to yell curse words and say derogatory terms towards staff when R1 is not given what they want.

All other facility residents were interviewed and no other residents reported any inappropriate behavior from S1, other staff, or other residents. All resident statements indicated that they are happy with the care provided at the facility. All staff interviewed did not report inappropriate behavior from S1. Facility Administrator, Juan Ramirez, stated, two weeks before R1's allegation, S1 was accused of inappropriately touching another caregiver on the back at a different facility. S1 admitted the behavior and agreed it was inappropriate. No other inappropriate behaviors were reported. S1 had previously worked at numerous facilities and two previous employers were interviewed. Both denied experiencing inappropriate behaviors from S1.

Based on staff interviews, S1 covered three over night shifts as a caregiver between 8/03/2024 and 8/05/2024. S1 worked 1800-0700 hours and, during this time, was alone with R1. On 8/03/2024, around 2200 hours, S1 claimed R1 had an accident that required R1 to be showered and dressed in new clothes. Though all staff agreed this type of incident would have been documented immediately, S1 did not document the accident until 8/21/2024, which was after R1 made the allegation.

** Report continued on 9099-C **

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20240918155401

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: WHOLESOME ELDERLY ON KIFISIA	FACILITY NUMBER: 345002823
	VISIT DATE: 12/04/2024

NARRATIVE

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S1 explained their delayed reporting was due to laziness and couldn't provide an explanation for the delayed reporting. However, S1 stated that other staff and R1's Power of Attorney knew about the accident.

S1 provided their own written statement regarding their innocence, stating the only interaction they had with R1 alone was when they needed to assist R1 with showering on 8/03/2024. S1 provided screen shot images depicting their daily locations between 8/03/2024 and 8/19/2024. The images were consistent with staff and S1's statements. S1 also stated that they did not expose themselves to R1.

Based on interviews conducted and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation 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 with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC9099 (FAS) - (06/04)

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