Complaint Investigation Report

312700042-6-6-2023-25-AS-KHOS-CSYP3K-20230620105740

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO NORTH ASC , 2525 NATOMAS PARK DR STE 270

This is an official report of an unannounced visit/investigation of a complaint received in our office on

02/14/2023 and conducted by Evaluator Melissa Parks

COMPLAINT CONTROL NUMBER: 25-AS-20230214091816

SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CARE

Facility staff failed to monitor resident's water and food intake resulting in hospitalization

Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Tuesday June 6, 2023, to complete and deliver findings to a complaint received on 2/14/2023. LPA met with Administrator Mark and explained purpose of visit.

LPA interviewed the Administrator and facility staff including nurses, med techs, caregivers, and activity staff. Med tech (S1) acknowledged they contacted the physician and POA regarding R1’s decline. S2, S3, and S4 stated that they offered snacks and hydration to R1. LPA reviewed R1’s file including the physicians report and assessment. The physicians report which was signed by a physician on 1/6/2023, stated that R1 had the capacity to feed themselves. Additionally, the facility assessment dated 1/7/2023, stated that R1 was independent for meals and did not require meal reminders. Due to the information above, LPA finds the allegation to be UNSUBSTANTIATED meaning 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 conducted with Administrator, copy of report was provided via email.