345920117-12-2-2024-59-AS-MSEY-DBMNV9-20241204094731

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345920117
Report Date: 12/02/2024
Date Signed: 12/02/2024 10:09:39 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
09/12/2024 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20240912152448

FACILITY NAME:	RAI ANGELS		FACILITY NUMBER:	345920117
ADMINISTRATOR:	RAI, BALWINDER		FACILITY TYPE:	740
ADDRESS:	6613 TRILBY CT.		TELEPHONE:	(916) 945-2122
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 4	DATE:	12/02/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Balwinder Rai, Administrator		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Licensee does not ensure that residents are provided with quality food while in care.
Licensee does not ensure that the facility has enough staff to meet the needs of resident(s) in care.
Licensee does not ensure that there is an adequate amount of supplies available to provide care to residents while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to complete a complaint investigation and deliver findings. LPA met with Balwinder Rai, Administrator, and Gary Rai, manager. Also present was care giver, Veron Reid. LPA observed (2) residents in the common area and (2) residents in their rooms. One resident requested to be sent to the hospital during today's inspection for back pain.

During today's inspection, LPA interviewed (2) residents, (1) care staff and (1) family member of a resident. Previously, LPA interviewed (1) caregiver and the Administrator. The facility was toured on 9/17/24 and on 12/2/24 to check for facility supplies, including food. Documentation was reviewed from residents' files including physician's reports, care plans and admission agreements.

The results of the investigation are as follows:

*cont on 9099C-1..

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

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 4

Control Number 59-AS-20240912152448

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: RAI ANGELS	FACILITY NUMBER: 345920117
	VISIT DATE: 12/02/2024

NARRATIVE

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9099C-1... Allegation: Licensee does not ensure that residents are provided with quality food while in care. The allegation states that residents are given non-nutritional food and food that is poor in quality.

LPA observed the food supply on 9/17/24. LPA observed several bags of groceries to be delivered during the inspection which included fresh and frozen vegetables, and other perishables such as yogurt and bread. The Administrator stated that bulk groceries are purchased on Tuesdays and additional groceries on a different day of the week, depending on the facility's needs.

The Administrator stated there is currently (1) resident (R1) with diabetes and the resident is offered a low carbohydrate diet as much as possible. Resident's physician's report, dated 8/5/24, notes (R1) has a secondary diagnosis of Type 2 Diabetes; however, does not indicate that (R1) has a special diet. The Administrator stated (R1) is offered sugar-free desserts as well as brown rice, and vegetables are offered at every meal. The Administrator showed LPA photos taken of meals prepared for residents during the month of October. Staff were asked to provide photos of meals served to ensure they are balanced. The Administrator stated she has had no complaints made about the quality of the food from residents or their families.

(2) staff were interviewed during the investigation. (1) staff stated on 9/17/24 that the facility has a menu and they "sometimes follow it". This staff stated what was served for breakfast and lunch that day and what was planned for dinner. This staff stated (R1) is not on a special diet, but they try not to give (R1) any spaghetti, caregivers will monitor (R1's) carbohydrates and (R1) will take his blood sugar once daily, before breakfast. A second staff stated on 12/2/24 that there is no "set menu" and residents are asked each day what they would like to eat for each meal, stating "most of the time, residents prefer the same food". This staff stated she doesn't take photos of meals served to residents and stated what will be served for dinner tonight. The Administrator stated staff only took photos of the meals in October 2024 for a month.

Both residents interviewed stated they are served fresh food, with a lot of fruits and veggies, and meals are freshly prepared, and the meals are rotated regularly. A family member stated the food seems good, and the facility consistently offers fruit and vegetables with each meal. The Ombudsman conducted a tour on 9/16/24 and did not observe any concerns.

Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED -meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. *cont on 9099C-2.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20240912152448

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: RAI ANGELS	FACILITY NUMBER: 345920117
	VISIT DATE: 12/02/2024

NARRATIVE

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*9099C-2... Allegation: Licensee does not ensure that the facility has enough staff to meet the needs of resident(s) in care. The allegation states there is insufficient staffing to provide care to all the residents.

One staff stated on 9/17/24 that there is sufficient staffing with (1) staff scheduled per shift, as there are currently (3) residents and no residents who required a two-person transfer. (2) of the (3) residents use a walker and (1) resident is ambulatory. This staff stated NOC staff are "on-call" and will rest in the common area if a resident requests assistance. Another staff stated on 12/2/24 that there are normally (2) staff scheduled, but today the Administrator is covering. This staff stated there are currently not any residents who are two-person transfers. During the NOC shift, there are either 1-2 staff scheduled.

Residents (2) stated there are usually (2) staff working on each shift, but sometimes there is (1) if there are less residents. One resident stated she is very independent and doesn't need much assistance, but she sees other residents receive assistance when it's requested. This resident indicated they receive prompt assistance when it's requested with one resident stating she rarely asks for assistance during the NOC shift, but when she does, she is promptly attended to. A family member that visits regularly stated there are 1-2 staff at each time he visits and staffing appears to be sufficient.

Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED -meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

Allegation: Licensee does not ensure that there is an adequate amount of supplies available to provide care to residents while in care. The allegation states the facility has minimal sheets, towels, disposables, wipes and equipment on hand.

LPA toured the facility on 9/17/24 and on 12/2/24 and observed sufficient amounts of sheets, towels, blankets, disposable wipes and Depends (diapers) on hand. Additionally, gloves, sanitizer and PPE supplies were observed. The Ombudsman conducted a tour on 9/16/24 and did not observe any concerns.

One staff,who was interviewed on 9/17/24, stated families are asked to provide Depends (diapers) but the facility has an emergency supply if needed.

*cont on 9099C-3.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20240912152448

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: RAI ANGELS	FACILITY NUMBER: 345920117
	VISIT DATE: 12/02/2024

NARRATIVE

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9099C-3... A second staff stated on 12/2/24 that families are only asked to provide wipes, and the facility provides Depends (diapers). This staff stated families are never asked to provide food, as it's freshly prepared on site daily.

One resident stated on 12/2/24 that she brought her own hygiene supplies with her. A second resident stated on 12/2/24 that she orders some supplies for herself, but the facility will provide supplies as needed.

One family member stated that families are asked to provide Depends (diapers), but he is not asked to bring wipes. The family member stated the facility does not ask that he bring food to his family member.

The Administrator stated she always asks residents and their families to provide Depends (diapers) and wipes, but she has back-up supplies, if needed.

The Admission Agreement notes that families are asked to provide briefs, wipes, and prescribed ointments and creams.

Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED -meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

There are no deficiencies issued.

Exit interview. Copy of report provided to the Administrator.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

LIC9099 (FAS) - (06/04)

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