Inspection Reports for Revel Folsom

2075 Iron Point Rd, Folsom, CA 95630, CA, 95630

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Inspection Report Annual Inspection Census: 42 Capacity: 60 Deficiencies: 0 Mar 12, 2025
Visit Reason
The inspection was conducted as a required annual unannounced visit to evaluate compliance with regulatory standards.
Findings
The Licensing Program Analyst reviewed resident and staff files, all containing required paperwork and training. The facility tour revealed no health or safety violations, and water temperatures were within the required range.
Employees Mentioned
NameTitleContext
Lavinia MuscanLicensing Program AnalystConducted the annual inspection and reviewed files.
Katherine MartinezEDMet with the Licensing Program Analyst during the inspection and toured the facility.
Leticia Fermoso HigaresAdministratorNamed as facility administrator.
Inspection Report Complaint Investigation Census: 42 Capacity: 60 Deficiencies: 0 Mar 6, 2024
Visit Reason
Unannounced complaint investigation visit conducted in response to an allegation that a resident was raped in the facility.
Findings
The investigation included interviews and record reviews but found no substantial evidence to support the allegation. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that a resident was raped in the facility. The resident had dementia and was unable to recall the incident. No incident reports or documentation were found to support the allegation. The Department found the allegation unsubstantiated.
Report Facts
Facility capacity: 60 Resident census: 42
Employees Mentioned
NameTitleContext
Brian PawloskiDirector of NursingMet with during the investigation and exit interview
Lavinia MuscanLicensing Program AnalystConducted the complaint investigation
Laura MunozLicensing Program ManagerNamed in report as Licensing Program Manager
Inspection Report Complaint Investigation Census: 42 Capacity: 60 Deficiencies: 0 Mar 6, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that a resident tested positive for a controlled substance which was not prescribed.
Findings
The investigation included interviews and record reviews and found no substantial evidence to support the allegation. The allegation was determined to be unsubstantiated.
Complaint Details
Allegation: Resident tested positive for a controlled substance which is not a prescribed medication. The investigation found that the resident tested positive for Fentanyl and amphetamine, but the resident's prescribed medications did not include these substances. The facility staff reported secure medication storage and no known staff misuse. Residents had no complaints. The Department concluded the allegation was unsubstantiated due to lack of preponderance of evidence.
Report Facts
Facility capacity: 60 Resident census: 42
Employees Mentioned
NameTitleContext
Brian PawloskiDirector of NursingMet with during investigation and named in findings
Lavinia MuscanLicensing Program AnalystConducted the complaint investigation
Laura MunozLicensing Program ManagerNamed in report as Licensing Program Manager
Inspection Report Annual Inspection Census: 42 Capacity: 60 Deficiencies: 0 Mar 6, 2024
Visit Reason
The inspection was conducted as a required unannounced annual inspection to evaluate compliance with regulatory standards.
Findings
The annual inspection found that all resident and staff files contained the required paperwork and training. The facility areas toured showed no health or safety violations, and food and water temperatures were within compliance. No deficiencies were cited during this inspection.
Employees Mentioned
NameTitleContext
Brian PawloskiDirector of NursingMet with during inspection and toured facility to ensure health and safety of residents.
Inspection Report Complaint Investigation Census: 46 Capacity: 60 Deficiencies: 0 Dec 11, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to multiple allegations received on 2023-11-03 regarding staff response times to call pendants, medication management, forced showers, staffing sufficiency, and supervision related to a resident fall.
Findings
The investigation found all allegations to be either unsubstantiated or unfounded after interviews, record reviews, and observations. There was no evidence of staff failing to respond timely to call pendants, mismanaging medications, forcing residents to shower, insufficient staffing, or improper supervision resulting in falls.
Complaint Details
The complaint investigation was unsubstantiated or unfounded for all allegations. Allegations included staff not responding timely to call pendants, medication mismanagement, forcing residents to shower, insufficient staffing, and lack of supervision causing a fall. Evidence did not support these claims.
Report Facts
Capacity: 60 Census: 46
Employees Mentioned
NameTitleContext
Talwinder BainsLicensing Program AnalystConducted the complaint investigation and delivered findings
Laura MunozLicensing Program ManagerOversaw the complaint investigation
Danielle PeckAdministratorFacility administrator met with during investigation
Leticia Fermoso HigaresAdministratorNamed as facility administrator in report header
Inspection Report Complaint Investigation Census: 46 Capacity: 60 Deficiencies: 0 Dec 11, 2023
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by an allegation that the facility elevator was in disrepair.
Findings
The investigation found that the elevator broke on 2023-12-05 and the facility promptly contacted a repair company. A new sensor was expected to arrive around 2023-12-12 to complete repairs. The elevator was temporarily out of service, but a plan was implemented to safely move residents downstairs. The allegation was unsubstantiated as no harm occurred to residents.
Complaint Details
The complaint was unsubstantiated. Although the elevator was broken, the facility took appropriate steps to address the issue and no harm was caused to residents.
Report Facts
Facility capacity: 60 Resident census: 46
Employees Mentioned
NameTitleContext
Talwinder BainsLicensing Program AnalystConducted the complaint investigation
Danielle PeckAdministratorMet with the investigator during the complaint investigation
Inspection Report Complaint Investigation Census: 42 Capacity: 60 Deficiencies: 0 Nov 8, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 2023-10-12 regarding staff mistreatment and abuse at the facility.
Findings
The investigation found all allegations to be unfounded after interviews, record reviews, and law enforcement involvement. No evidence of staff slapping, intimidating, or abusing residents was found, and residents reported respectful treatment by staff.
Complaint Details
The complaint included allegations that staff slapped a resident, intimidated a resident, did not report physical abuse, and did not treat clients with dignity and respect. The investigation determined these allegations were unsubstantiated and unfounded.
Report Facts
Capacity: 60 Census: 42
Employees Mentioned
NameTitleContext
Brian PawloskiDirector of NursingMet with during the complaint investigation and mentioned in findings
Lavinia MuscanLicensing Program AnalystConducted the complaint investigation
Laura MunozLicensing Program ManagerNamed in report as Licensing Program Manager
Inspection Report Complaint Investigation Census: 42 Capacity: 60 Deficiencies: 0 Nov 8, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2023-10-26 regarding staff not acknowledging a resident's new Power of Attorney (POA) documents.
Findings
The investigation found that the resident (R1) was admitted on 2023-07-27 and has a family member as their POA. Based on medical diagnosis, R1 is not competent to change the POA. Staff acknowledged another family member's request to be POA but cannot address it. The allegation was determined to be unfounded.
Complaint Details
The complaint alleged that staff were not acknowledging the resident's new POA documents. The investigation concluded the allegation was unfounded, meaning it was false or without reasonable basis.
Report Facts
Complaint Control Number: 59 Facility Capacity: 60 Census: 42
Employees Mentioned
NameTitleContext
Brian PawloskiDirector of NursingMet with during the investigation and named in findings
Lavinia MuscanLicensing Program AnalystConducted the complaint investigation
Laura MunozLicensing Program ManagerNamed in report header
Inspection Report Complaint Investigation Census: 42 Capacity: 60 Deficiencies: 0 Oct 11, 2023
Visit Reason
The inspection visit was conducted as an unannounced complaint investigation following a complaint received on 2023-08-17 regarding insufficient staffing to meet residents' needs.
Findings
The investigation found no evidence to support the allegation of insufficient staffing. Facility schedules showed adequate staff coverage with at least two direct care staff per floor per shift, and residents reported their needs were met. The allegation was determined to be unfounded.
Complaint Details
The complaint alleged insufficient staffing to meet residents' needs. The allegation was investigated and found to be unfounded, meaning it was false or without reasonable basis.
Report Facts
Facility capacity: 60 Census: 42
Employees Mentioned
NameTitleContext
Lavinia MuscanLicensing Program AnalystConducted the complaint investigation and delivered findings
Danielle PeckExecutive DirectorMet with Licensing Program Analyst during investigation
Leticia Fermoso HigaresAdministratorNamed as facility administrator
Inspection Report Complaint Investigation Census: 40 Capacity: 60 Deficiencies: 0 May 16, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2023-05-04 alleging that a resident pushed another resident causing a hip fracture.
Findings
The investigation included interviews, review of medical records, incident reports, and video footage. The department concluded the allegation was unfounded as the incident was confirmed to have occurred but the facility responded appropriately by activating EMS and notifying responsible parties. No citations were issued.
Complaint Details
The complaint alleged that a resident pushed another resident causing a hip fracture. The investigation found that the incident occurred as described, but the facility acted appropriately in response. The allegation was determined to be unfounded, meaning it was false, could not have happened, or lacked reasonable basis.
Report Facts
Facility capacity: 60 Resident census: 40
Employees Mentioned
NameTitleContext
Sarena KeosavangLicensing Program AnalystConducted the complaint investigation and authored the report
Anthony PerezLicensing Program ManagerNamed as Licensing Program Manager on the report
Danielle PeckExecutive DirectorMet with Licensing Program Analyst during the investigation and exit interview
Inspection Report Complaint Investigation Census: 37 Capacity: 60 Deficiencies: 2 Mar 8, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2022-07-18 regarding allegations of untimely response to a resident's representative's request for assistance and insufficient staffing to meet resident needs.
Findings
The investigation substantiated that the facility failed to respond timely to a resident's representative's request for assistance, evidenced by unclean bathrooms for several days. Additionally, while staffing numbers were sufficient, staff were not properly trained to meet resident needs, resulting in insufficient competent personnel.
Complaint Details
The complaint investigation was substantiated. The allegations included untimely response to a resident's representative's request for assistance and insufficient staffing. The investigation found feces on a toilet seat that was not cleaned for several days and staff not properly trained to respond to resident requests, confirming the allegations.
Severity Breakdown
Type B: 2
Deficiencies (2)
DescriptionSeverity
Multiple bathrooms were unclean in residents' rooms, posing a potential health, safety, and personal rights risk.Type B
Facility staff were not competent to provide necessary services to meet resident needs due to lack of training.Type B
Report Facts
Capacity: 60 Census: 37 Deficiencies cited: 2 Plan of Correction Due Date: Mar 17, 2023
Employees Mentioned
NameTitleContext
Lavinia MuscanLicensing Program AnalystConducted the complaint investigation and authored the report
Laura MunozLicensing Program ManagerOversaw the complaint investigation
Thach N DuongAdministratorFacility administrator met during investigation and exit interview
Inspection Report Annual Inspection Census: 35 Capacity: 60 Deficiencies: 0 Feb 10, 2023
Visit Reason
The inspection was an unannounced Required-1 Year Inspection focusing on the infection control domain to ensure health and safety compliance at the facility.
Findings
No immediate health, safety, or personal rights violations were observed. The facility was found to be in substantial compliance with infection control requirements, and no deficiencies were cited.
Report Facts
Capacity: 60 Census: 35
Employees Mentioned
NameTitleContext
Thach Jimmy DuongExecutive DirectorMet with Licensing Program Analyst during inspection
Sarena KeosavangLicensing Program AnalystConducted the inspection
Anthony PerezLicensing Program ManagerNamed in report header
Inspection Report Plan of Correction Census: 21 Capacity: 60 Deficiencies: 1 Mar 29, 2022
Visit Reason
Unannounced Plan of Correction (POC) visit to verify correction of previous deficiencies.
Findings
The Licensing Program Analysts toured the facility and observed four resident rooms and bathrooms to be clean and sanitary. The deficiency was cleared during the inspection. The administrator was instructed to submit a plan to maintain cleanliness of resident bathrooms by 3/31/22.
Deficiencies (1)
Description
Resident bathrooms not maintained in a clean and sanitary condition prior to correction.
Report Facts
Capacity: 60 Census: 21
Employees Mentioned
NameTitleContext
Mustafa Ali-MahgoubAdministratorMet with Licensing Program Analysts during the inspection.
Bethany MirlohiLicensing Program AnalystConducted the POC visit.
Lavinia MuscanLicensing Program AnalystConducted the POC visit and signed the report.
Troy OrdonezLicensing Program ManagerNamed in the report header.
Inspection Report Annual Inspection Census: 19 Capacity: 60 Deficiencies: 1 Feb 28, 2022
Visit Reason
The visit was an unannounced annual inspection conducted to ensure the health and safety of residents in care, including completion of COVID-19 testing protocols and infection control review.
Findings
During the inspection, no immediate health, safety, or personal rights violations were observed except that 2 of 4 resident bathrooms were found unclean with feces present on the floor and toilets, resulting in cited deficiencies.
Deficiencies (1)
Description
2 out of 4 resident bathrooms were unclean with feces present on the floor and toilets, posing a potential health, safety or personal rights risk to persons in care.
Report Facts
Resident bathrooms unclean: 2 Resident bathrooms toured: 4
Employees Mentioned
NameTitleContext
Bethany MirlohiLicensing Program AnalystConducted the inspection and authored the report
Leticia HigaresAdministratorFacility administrator met with Licensing Program Analyst during inspection and responsible for plan of correction
Troy OrdonezLicensing Program ManagerSupervisor overseeing the inspection
Inspection Report Census: 14 Capacity: 60 Deficiencies: 0 Aug 3, 2021
Visit Reason
The visit was a Case Management - Incident visit conducted following receipt of an Incident Report and a Report of Suspected Dependent Adult/Elder Abuse related to a resident's recent trip to the ER.
Findings
No deficiencies were cited as a result of the visit. The Licensing Program Analyst conducted interviews, toured the facility, and requested additional documentation for review.
Employees Mentioned
NameTitleContext
Jennifer ScarberryAdministratorInterviewed during the visit.
Konnor LeitzellLicensing Program AnalystConducted the Case Management Visit.
Inspection Report Original Licensing Capacity: 60 Deficiencies: 3 Mar 4, 2021
Visit Reason
The visit was a prelicensing inspection conducted virtually due to COVID-19 precautionary measures to evaluate the facility prior to licensure.
Findings
Several deficiencies were identified related to kitchen appliance temperatures and screening procedures for visitors and staff, all of which were corrected prior to completion of the report. The Licensing Program Analyst toured the facility and found no other deficiencies, approving the prelicensing inspection.
Deficiencies (3)
Description
Freezer in kitchen must be maintained at a temperature of 0 degrees F
Refrigerator in kitchen must be maintained at a maximum temperature of 40 degrees F
Screening for visitors and staff at the front entrance of facility including temperature check and COVID-19 questions
Report Facts
Capacity: 60 Census: 0
Employees Mentioned
NameTitleContext
Janelle LopezAdministratorFacility administrator present during prelicensing inspection
Konnor LeitzellLicensing Program AnalystConducted the prelicensing inspection
Troy OrdonezLicensing Program ManagerNamed in report header
Inspection Report Original Licensing Capacity: 60 Deficiencies: 0 Jan 5, 2021
Visit Reason
Initial licensing evaluation for a new Residential Care Facility for the Elderly with dementia care, including verification of applicant and administrator qualifications and understanding of regulatory requirements.
Findings
The applicant and administrator successfully completed the Component II evaluation via call with the analyst, confirming understanding of Title 22 regulations and facility operation requirements. Technical assistance was provided on various licensing and operational topics.
Report Facts
Capacity: 60 Census: 0
Employees Mentioned
NameTitleContext
Janelle LopezAdministratorFacility administrator who participated in the licensing evaluation
Jude De La ConcepcionLicensing Program ManagerNamed as Licensing Program Manager on the report
Bethany HunterLicensing Program AnalystConducted the Component II evaluation and signed the report

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