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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345002930
Report Date: 05/17/2023
Date Signed: 05/17/2023 03:47:28 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
03/07/2023 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20230307081733
FACILITY NAME:MAMA CLAUDIA'S LOVING NESTFACILITY NUMBER:
345002930
ADMINISTRATOR:MIHAI, CLAUDIAFACILITY TYPE:
740
ADDRESS:4230 PARADISE DR.TELEPHONE:
(916) 745-9876
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 5DATE:
05/17/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:caregiverTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff does not ensure residents receive assistance with activities of daily living

Staff does not ensure residents special dietary restrictions are being followed

Staff does not ensure food is of good quality
INVESTIGATION FINDINGS:
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On (Date) , Licensing Program Analyst (LPA) Kevin Mknelly LPA Mknelly arrived and met with licensee to deliver investigation findings.

LPA reviewed facility records, resident records, conducted interviews and conducted 5 facility visits.
LPA finds that facility met Tittle 22 requirements.

Staff does not ensure residents receive assistance with activities of daily living- On all facility visits conducted, residents were found to be clean and well groomed. Residents interviewed who were able to recall events reported being happy with the care they received.

Staff does not ensure residents special dietary restrictions are being followed- R1’s hospice care plan was reviewed and hospice agency staff were interviewed. Care plan identified regular diet with no restrictions. R1 is identified as having diabetes. Interviews conducted found staff had followed guidance
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
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 59-AS-20230307081733
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: MAMA CLAUDIA'S LOVING NEST
FACILITY NUMBER: 345002930
VISIT DATE: 05/17/2023
NARRATIVE
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to encourage R1 to consume limited carbohydrates and sugars. However, Staff file reviews found that proof of restricted health condition training, diabetes, were not present in the records provided to the department.

Staff does not ensure food is of good quality- Facility food was found during inspections to meet regulation requirements for nutritional value, food safety and quality.

This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted and report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2