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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345002930
Report Date: 09/20/2023
Date Signed: 09/20/2023 12:15:12 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
07/18/2023 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20230718154908
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: 6DATE:
09/20/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Obriana Graydon, CaregiverTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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-Staff did not ensure that a written resident personal property inventory was established upon admission and retained during the resident’s stay.
-Staff did not safeguard resident's belongings while in care.
-Staff emotionally abused resident while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home on 9/20/2023 and met with the caregiver, Obriana Graydon, to deliver findings into the above listed allegations.

During the course of the investigation, LPA conducted interviews and reviewed documentation pertinent to the investigation.




********************************************Continued on LIC9099-C*************************************************
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
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 3
Control Number 59-AS-20230718154908
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: MAMA CLAUDIA'S LOVING NEST
FACILITY NUMBER: 345002930
VISIT DATE: 09/20/2023
NARRATIVE
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Allegation: Staff did not ensure that a written resident personal property inventory was established upon admission and retained during the resident’s stay.
The complaint is regarding the facility not keeping an inventory of resident (R1’s) belongings. Interview with the Administrator indicated that, anytime there is an admission to their facility, they offer to have the Client/Resident Personal Property and Valuables LIC621 form completed. The Administrator indicated that R1’s responsible party took all the admission documentation home to review when R1 was admitted to the facility. Interview with the Administrator also indicated that R1’s responsible party declined to complete the LIC621. R1’s LIC621 indicated that R1 has no property or valuables and arrived at the facility with “a few clothing items”.

Allegation: Staff did not safeguard resident’s belongings while in care.
The complaint is regarding R1 missing items upon discharge from the facility and facility staff not ensuring R1’s clothing was not worn by other residents. Interviews with the Administrator and staff (S1) indicated that R1’s responsible party would often arrive at the facility with a bag to exchange out clothing items in R1’s room. Interview with S1 indicated that there was an incident when hospice arrived to provide care for resident (R3) and, when they changed R3’s clothing, the hospice staff accidentally put one of R1’s shirts on R3. S1 indicated that R1 and R3 shared a dresser and closet. S1 indicated that they changed R3’s shirt as soon as it was noticed they were wearing R1’s clothing. S1 indicated that this was the only occasion that R3 was wearing R1’s clothing. Interview with relevant party indicated that R1 was missing several items upon discharge such as the footrests from R1’s wheelchair, a pillow, electric toothbrush, and purple garment. Interview with Administrator indicated that they attempted to provide the footrests to R1’s responsible party. Administrator indicated that they purchased a new pillow and electric toothbrush for R1 and dropped it off at R1’s new residence. Interview with relevant party indicated that the footrests were not the correct footrests for R1’s wheelchair, the pillow was not the same brand or value, and the electric toothbrush was not the same brand as the original toothbrush so refills could not be used. The items that the relevant party indicated were missing were not listed on R1’s Personal Property and Valuables LIC621.



*********************************************Continued on LIC9099-C************************************************
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20230718154908
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: MAMA CLAUDIA'S LOVING NEST
FACILITY NUMBER: 345002930
VISIT DATE: 09/20/2023
NARRATIVE
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Allegation: Staff emotionally abused resident while in care.
The complaint is regarding concern that the Administrator and other facility staff were emotionally abusing R1. Interviews conducted with resident (R2) and S1 indicated that they have never witnessed any abuse of any kind at the facility. Interview with R2 indicated that they have never experienced emotional abuse from staff and never witnessed staff mistreating R1. During the interview with R1, their responsible party was present. R1 indicated that they were scared and upset when the Administrator informed R1 they were moving out of the facility. Interviews with hospice staff indicated that they were able to speak to R1 privately at the facility on several occasions so that R1 could be open about any concerns. Hospice staff indicated that R1 would always indicate that they were happy at the care home. Hospice staff had also conducted a welfare check at the facility and spoke with R1 privately. Hospice staff indicated that R1 seemed comfortable, smiled, and indicated that they were happy. Interview with hospice staff also indicated that there were no indications of R1 being neglected or abused, neither verbal nor any other. Interview with outside agency representative indicated that they have stayed at the facility often and have interviewed all the residents. The outside agency representative indicated, from what they have observed, there were no signs of emotional abuse with any of the residents in care.

Based on interviews conducted and documentation reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies are being cited during this visit.

Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
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