347003472-6-20-2023-59-AS-MSEY-CT6LVQ-20230626090551

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347003472
Report Date: 06/20/2023
Date Signed: 06/20/2023 02:33:45 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, 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
03/28/2023 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20230328181245

FACILITY NAME:	CORNELIA'S RCFE		FACILITY NUMBER:	347003472
ADMINISTRATOR:	CORNELIA CATA		FACILITY TYPE:	740
ADDRESS:	5422 NORTH AVENUE		TELEPHONE:	(916) 489-3299
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 6	DATE:	06/20/2023
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Madeline Cata		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Residents are chemically restrained with medication
Facility staff not fingerprint-cleared
Staff are using drugs while on duty
Facility staff are abusing residents

INVESTIGATION FINDINGS:

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On 6/20/23 , Licensing Program Analyst (LPA) Kevin Mknelly LPA Mknelly arrived and met with caregiver to deliver investigation findings.
LPA reviewed staff records and facility records.
Residents only able to provide limited responses stating satisfaction with care
LPA finds that facility met Tittle 22 requirements.
Observation, interviews and records reviews found no evidence of staff drug use, medication administration of medications as prescribed only, and no evidence of abuse of residents.
Employees are the licensee and licensee's family and are all associated to the facility.
While present, LPA advised food storage and medication prepouring systems be updated.
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.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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