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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 03:53:50 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
03/15/2023 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20230315105130
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:
02:40 PM
MET WITH:licenseeTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Facility staff refusing to allow resident to have visitor.
INVESTIGATION FINDINGS:
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On 5/17/23, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Licensee.

LPA conducted records review and extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.

Statements received from relevant parties during the course of the investigation found that, while R1 was receiving care at the level defined by their hospice agency, the relationship between the facility staff and R1's responsible party was often contentious. Efforts by the hospice agency, CCL, law enforcement and the Long-term Care Ombudsman were unsuccessful in resolving the relationship between the representative and facility staff. R1's representative had visited the facility often. On the date of the reported event, 3/14/23, the hospice MD, was reported to have, directed the representative to go outside in order to examine R1 without distraction.
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-20230315105130
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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During the period of the investigation, between 3/15/23 to 4/19/23, R1’s representative and licensee provided numerous communications and reports of the others’ alleged behaviors. In those reports, it appears that R1 would be provided the opportunities for visitation when the visiting party was not disruptive to the care and well being of others. All other residents were reported to not have visitation restrictions.

R1 reported that they believe that they are allowed visitation.

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 with administrator.
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