<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397000839
Report Date: 09/07/2023
Date Signed: 09/22/2023 11:16:00 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/27/2023 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20230627104114
FACILITY NAME:MARY FRANCES HAT RESIDENTIAL FACILITYFACILITY NUMBER:
397000839
ADMINISTRATOR:LAURA REEVESFACILITY TYPE:
740
ADDRESS:14381 E. SARGENT ROADTELEPHONE:
(209) 334-6454
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:6CENSUS: 3DATE:
09/07/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator, Laura ReevesTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is retaining a resident with a higher level of care needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
****THIS DOCUMENT WAS AMENDED TO CHANGE THE FINDING FROM UNFOUNDED TO UNSUBSTANTIATED AND TO CORRECT THE DATE.**
On 09/07/23, Licensing Program Analyst Renee Campbell arrived at Mary Francis Hat Residential Facility unannounced to conclude investigation 27-AS-20230627104114. LPA met with Laura Reeves and explained the purpose of the visit.
Regarding the allegation, “Facility is retaining a resident with a higher level of care needs”, LPA obtained information that the facility notified the responsible party that R1 was in decline and in need of hospice care on approximately 6/8/23. On 06/22/23, R1’s primary care doctor referred R1 for hospice care. LPA observed an email on 6/23/23, whereas the administrator, Laura Reeves informed the responsible party of the doctor’s referral and requested feedback. The administrator reached out to the Service Coordinator for an update on approval for hospice care for R1. The facility has a waiver for 2 hospice residents. At this time, there are 0 residents receiving hospice care services. The investigation revealed that the primary care physician and Senior Community Liason for the hospital, reached out to the responsible party, explained the need for hospice care, at which time, the responsible party declined hospice care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
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 2
Control Number 27-AS-20230627104114
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: MARY FRANCES HAT RESIDENTIAL FACILITY
FACILITY NUMBER: 397000839
VISIT DATE: 09/07/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on facility having an approved waiver for two hospice residents, at which time there were zero, the allegation is deemed as unsubstantiated. This agency has investigated the complaint alleging "Facility is retaining a resident with a higher level of care needs". 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. We have therefore dismissed the complaint.” Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited. An exit interview was held and a copy of this report was provided.
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2