347003892-10-15-2024-27-AS-KHOS-DA9M88-20241021092243

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347003892
Report Date: 10/15/2024
Date Signed: 10/15/2024 11:28:36 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
09/20/2024 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240920165941

FACILITY NAME:	CARE PROVIDERS AT ARDEN		FACILITY NUMBER:	347003892
ADMINISTRATOR:	APUYA, MARY JANE		FACILITY TYPE:	740
ADDRESS:	4448 ARDEN WAY		TELEPHONE:	(916) 489-1883
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95864
CAPACITY:	6	CENSUS: 4	DATE:	10/15/2024
		UNANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:	Anny Viernes		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Staff are not administering medications to residents as prescribed.
Staff are not providing adequate food service to resident.

INVESTIGATION FINDINGS:

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On 10/15/2024 at 10:22 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with care staff Anny Viernes and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 4. A brief interview with conducted with care staff Anny.

Allegations were made regarding staff not administering medications to residents as prescribed. The investigation involved reviewing records, conducting observations, and interviewing staff and residents. LPA Lee alongside with administrator Mary Apuya audit and reviewed 4 out 4 resident’s Centrally Stored medication Destruction Record along with the resident’s medication and no deficiencies were found during the review. Based on the interviews and statements obtained during the investigation process, LPA Lee was unable to corroborate the allegation. 4 out of 4 residents reported no concerns regarding medication administration and stated that they are receiving medications from facility staff. Moreover, 2 out of 2 staff members interviewed denied the allegations.
Continued LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

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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Control Number 27-AS-20240920165941

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CARE PROVIDERS AT ARDEN	FACILITY NUMBER: 347003892
	VISIT DATE: 10/15/2024

NARRATIVE

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Allegations were made that staff do not provide adequate food service to residents in care. This investigation included observations and interviews with staff and residents. It was learned that the facility purchased 2 days perishable food every two weeks. During facility visits on 09/24/2024, LPA Lee observed that adequate food service was provided during breakfast. During today’s visit, it was observed resident was provided adequate food to residents in care during breakfast. Additionally, LPA Lee noted that the facility had a sufficient supply of food, including two days' worth of perishable items and seven days' worth of non-perishable items on 09/24/2024 and during today’s visit. Based on the interviews conducted during the investigation, LPA Lee could not corroborate the allegations. 4 out of 4 residents interviewed expressed no concerns regarding the adequacy of food provided. Furthermore, all 2 out of 2 staff members denied the allegations.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.
Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies were cited.
A copy of this report was provided to care staff Anny Viernes. Exit interview.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

LIC9099 (FAS) - (06/04)

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