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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 03:52:42 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
03/13/2023 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20230313144204
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:
02:00 PM
MET WITH:LicenseeTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Resident sustained severe pressure injuries due to staff neglect
Staff did not notify resident’s authorized representative of injuries
Staff are retaliating against resident for filing a complaint
Staff are threatening resident
INVESTIGATION FINDINGS:
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On 5/17/23 , Licensing Program Analyst (LPA) Kevin Mknelly LPA Mknelly arrived and met with licensee to deliver investigation findings.

The department reviewed facility records, resident records, conducted interviews and conducted 4 facility visits.
LPA finds that facility met Tittle 22 requirements.

Resident sustained severe pressure injuries due to staff neglect- In Hospice records review and interviews is was found that R1’s pressure injuries had resolved to stage one as of 3/22/23. According to hospice records, as of 03/20/2023, all of R1's pressure injuries are stage two or one. Hospice provides wound care of the pressure injuries and no neglect or questionable practices by facility staff were reported by hospice records or statements.
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-20230313144204
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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Staff did not notify resident’s authorized representative of injuries- Records and statements found that R1’s authorized representative was informed of pressure injuries though there may have been some miscommunication between the licensee, representative and hospice between the time the wounds were discovered, 3/9/23 and hospice MD assessment on 3/14/23.

Staff are retaliating against resident for filing a complaint- R1 did not file a complaint. Staff and R1 report no retaliation of decrease in quality of care by staff for R1. Statements found a dispute between R1’s representative and the licensee regarding R1’s requests of the facility staff.

Staff are threatening resident- Observations and interviews found staff to have supportive and professional interactions with residents.

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