Revere Court

Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to the Revere Court RCFE on 10/29/25 at 1:05pm to conclude the investigation of the above allegation and to deliver the findings. LPA Gould met with Administrator Marina Smetyukh and together discussed the investigation details. Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. The department obtained and reviewed R1's death certificate which did not indicate any cause that was determined to be questionable. LPA Gould conducted interviews with nine (9) staff members. All interviews conducted did not corroborate the allegations listed inthe complaint. Per staff statements, hospice notes reviewed and staff communications and daily notes all indicated that as R1 was declining and on hospice care, as part of R1's decline R1 was reported to have had a decline in appetite and would not consuRead the full finding— CDSS inspection report, October 29, 2025 · control 27-AS-20250303114503

On 12-31-2024 at 1:50pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced at facility to deliver and discuss findings for the allegations noted above. LPA met with Executive Director Irene Charnell and explained the purpose of the visit. During this investigation, LPA conducted interviews with six staff members, three additional witnesses, and reviewed facility file documentation including caregiver schedule, and employee records. Additionally, LPA conducted facility observations on 10/24/2024 and 12/4/2024. Allegation: Staff do not ensure residents are spoken to in an appropriate manner. LPA conducted interviews and observation as noted above. Based on interviews and observation conducted, it was determined that facility is exclusive to memory care. Interviews did not reveal any corroborated statements of staff speaking inappropriately to residents in care. Observations were conducted by LPA in all four cottages serving memory care residents and consisted of variousRead the full finding— CDSS inspection report, December 31, 2024 · control 27-AS-20241015084008

On 12-4-24 at 1:35pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced at facility to deliver and discuss findings for the allegations noted above. LPA met with Executive Director Irene Charnell and explained the purpose of the visit. During this investigation, LPA conducted interviews with six staff members and reviewed facility file documentation including caregiver schedule, employee records, and pest control agreement. Additionally, LPA conducted facility observations on 10/24/2024 and 12/4/2024. Allegation: Licensee does not ensure facility is kept free of pests. LPA conducted interview and observation as noted above. Observation conducted did not reveal the presence or evidence of pests within the facility. Interviews conducted revealed that although facility has a history of presence of pests, a pest control service is conducted regularly since 4/19/2022 with most recent service conducted 12/4/2024. {Cont. on 9099C} UnsubstantiatedRead the full finding— CDSS inspection report, December 4, 2024 · control 27-AS-20241015084008

Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to the Revere Court RCFE on 5/9/24 at 1:30pm to conclude the investigation of the above allegations and to deliver the findings. LPA Gould met with Administrator, Irene Charnell and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. LPA Gould conducted interviews with five (5) staff members and three (3) residents in building 1. Per the staff interviews, LPA could not corroborate that an altercation occurred between R2 and R3. Both residents interviewed could not recall or describe the alleged incident. Per R2, she has had only one fall at the facility and it occurred in the bathroom when sick. R2 could not recall if staff were aware of this fall. LPA was unable to corroborate the fall as a result of one resident pushing another. All staff interviewed denied any knowledge of the descRead the full finding— CDSS inspection report, May 9, 2024 · control 27-AS-20240402081017

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 10/27/21 at 11:47am to conclude the investigation regarding the above-mentioned allegation. LPA met with Brenda Chappell and discussed the purpose of the visit. LPA requested a copy of the Admission agreement including the Respite agreement for resident #1 (R1), contact phone numbers of staff, and Admission Record (Face Sheet). Regarding allegation, “Resident sustained major injury while in care”, LPA reviewed facility documents and medical records and conducted interviews. LPA observed a Special Incident Report (LIC624(SIR)) dated 7/9/21 that indicates resident #1 (R1) fell and was sent to the emergency room for a cheek laceration. UnsubstantiatedRead the full finding— CDSS inspection report, October 27, 2021 · control 27-AS-20210712163451

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 10/20/21 at 1:20pm to conclude the complaint investigation of the above-mentioned allegation. LPA was met by Brenda Chappell and stated the purpose of the visit. Regarding, allegation, “Facility is not allowing resident to leave the facility”, LPA observed that on 5/3/21, Sacramento City Police Department (SPD) was involved when there was an attempt to remove Resident #1 (R1) from the facility without the knowledge of the Responsible Party (RP), at which time it was deemed there was not a court order to remove R1 from the facility. The Physician Report (LIC602) dated 4/1/21 indicates R1 was diagnosed with vascular dementia. LPA also observed the Advance Health Care Directive dated 12/3/15 which appoints an agent to make healthcare decisions for R1. LPA observed there are several documents such as petitions for hearings, letters from attorneys, conservatorship requests, narrative charting regarding calls that R1 receiRead the full finding— CDSS inspection report, October 20, 2021 · control 27-AS-20210519092416

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conclude the investigation of the above mentioned allegations on 10/15/21 at 2:00pm. LPA met with Brenda Chappell and stated the purpose of the visit. Regarding allegation, "Resident not allowed to have visitors" LPA received the visitation protocol which indicates an update in accordance with the new guidelines from CDSS. During interviews with staff, LPA obtained information that visitation protocols were given to the responsible parties (RP) and any others requested by the (RP) via email. In addition, copies were readily available to visitors upon entry to the facility as stated in the Provider Information Notices (PIN)s. In this case, the protocols were handed to the family. Upon arrival during the visits, the family would not wear masks properly which puts the community residents at risk. Family was reminded of the proper way to wear the masks during the visits. LPA reviewed the Resident Off Campus Register andRead the full finding— CDSS inspection report, October 15, 2021 · control 27-AS-20210511112140