345002872-7-17-2025-59-AS-KHOS-DK4L28-20250731082156

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002872
Report Date: 07/17/2025
Date Signed: 07/17/2025 02:39:22 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
04/11/2025 and conducted by Evaluator Michael Hood

COMPLAINT CONTROL NUMBER: 59-AS-20250411114909

FACILITY NAME:	CENTURY CARE HOME		FACILITY NUMBER:	345002872
ADMINISTRATOR:	SOLOVYEV, RALUCA DELIA		FACILITY TYPE:	740
ADDRESS:	5725 CENTURY WAY		TELEPHONE:	(916) 254-9557
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	6	CENSUS: 6	DATE:	07/17/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Alena Tripadush, Administrator		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Staff neglect resulted in a resident being hospitalized

Staff did not timely address a resident's change in medical condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Alena Tripadush, to deliver findings into the complaint allegations listed above.

During the investigation, LPA conducted interviews and the Department obtained and reviewed records pertinent to the investigation. The results of the investigation are as follows:

Relevant party reported to the Department that resident (R1) had to be hospitalized due to a Urinary Tract Infection (UTI).

** Report continued on 9099-C **

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20250411114909

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: CENTURY CARE HOME	FACILITY NUMBER: 345002872
	VISIT DATE: 07/17/2025

NARRATIVE

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R1 was seen at the hospital emergency room on March 24, 2025 due to abdominal pain. The medical records indicate that R1 was diagnosed with a UTI. R1 was discharged a few hours later and prescribed antibiotics. It was determined by the Department that the hospitalization was not for severe injury or great bodily harm. Additional hospital records from April 12, 2025 to April 16, 2025 were also reviewed by the Department. There were no indicators that additional hospital visits were due to staff neglect or due to staff failing to seek timely medical care.

On April 12, 2025, R1 was seen at the Emergency Room due to a chief complaint of sepsis alert. R1 was admitted due to suspected pneumonia and physical deconditioning. R1 exhibited symptoms of confusion and shortness of breath, having experienced a week of cough and malaise, along with a day of altered consciousness. Tests revealed consistencies with R1’s baseline interstitial lung disease (ILD) and possible pneumonia. Computed Tomography (CT) scan showed findings of jejunal intussusception, but it was determined that no surgical intervention was necessary. On April 16, 2025, R1 returned to the Emergency Department with a complaint of abdominal pain and nausea. CT scan once again showed jejunal intussusception. Again, surgical intervention was not recommended. Push enteroscopy was performed on April 22, 2025. Procedure did not identify a clear cause for the intussusception. R1 was also treated again for UTI with antibiotics. CT scan on April 22, 2025 indicated that previously noted jejunal intussusception was no longer present.

Unusual Incident/Injury Report (SIR) dated March 25, 2025 indicated that, on March 24, 2025, R1 was sent to the hospital due to nausea and back pain. R1 was treated with antibiotics for a UTI. SIR dated April 16, 2025 for R1 indicated that, on April 12, 2025, R1 complained of leg and arm pain. Facility offered to transfer R1 to be medically evaluated at the hospital. R1 informed paramedics that they were sustaining abdominal pain. R1 was treated for pneumonia and returned to the facility with new medication. SIR dated April 22, 2025 indicated that, on April 16, 2025, R1 told staff that they feel sick to their stomach. R1 was transferred to the hospital per request. SIR indicated that R1 was kept for more testing due to abnormalities found with CT scan. R1 did not return to the facility after hospital visit on April 16, 2025.

** Report continued on 9099-C **

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20250411114909

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: CENTURY CARE HOME	FACILITY NUMBER: 345002872
	VISIT DATE: 07/17/2025

NARRATIVE

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R1’s Physician’s Report LIC 602A dated December 3, 2024 indicates R1’s primary diagnosis is major depressive disorder, recurrent and unspecified. R1’s secondary diagnosis is accidental poisoning by insulin and/or hypoglycemic. R1 does not have cognitive impairment and is able to communicate needs. R1 is identified as non-ambulatory. LPA reviewed R1's Centrally Stored Medication Form (CSMF) and observed R1 was prescribed a five (5) day supply of antibiotics on March 25, 2025. LPA did not observe any indication that medications were not given as needed.

Interviews conducted with residents R2, R3, and R4 indicated that residents feel they are treated well by facility staff and they feel that their care needs are being met.

Based on interviews conducted and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are 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. A copy of the report provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025

LIC9099 (FAS) - (06/04)

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