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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005861
Report Date: 03/19/2024
Date Signed: 03/19/2024 10:26:53 AM

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
01/02/2024 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20240102084754
FACILITY NAME:GRANDMA'S HOME IIFACILITY NUMBER:
347005861
ADMINISTRATOR:MEHEDINTI, MIHAILFACILITY TYPE:
740
ADDRESS:6520 MILES LANETELEPHONE:
(916) 696-6542
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:4CENSUS: 2DATE:
03/19/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mihail MehedintiTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff slapped resident.
INVESTIGATION FINDINGS:
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On 3/19/24, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with the licensee.

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

Information from a treating hospital for R1 was that when R1 was examined on 12/28/24, “No new signs of trauma were appreciated on my examination.”
Family of R1 had been told by R1 that a staff at the facility had hit R1. R1 did not provide details of who allegedly hit them or when.
The family member for R1 had also been contacted by S3. LPA interviewed S3.
S3 and S1 made counter allegations about each others behavior. S3 did not observe S1 slapping R1.
LPA Mknelly conducted a collateral visit to the new home that R1 was moved to.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
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 2
Control Number 59-AS-20240102084754
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: GRANDMA'S HOME II
FACILITY NUMBER: 347005861
VISIT DATE: 03/19/2024
NARRATIVE
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The Licensee at R1’s new home stated that R1 is demonstrating behaviors at that home too and has made vague allegations of staff hitting R1. The licensee has investigated the allegations and found them to not be credible.

While this allegation is found to be unsubstantiated, there were some deficiencies observed to have occurred. Those deficiencies are noted in a separate report.

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview with administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2