Rock Creek Senior Care

Allegation investigated: Staff physically assulted a resident causing injury resulting in hospitalization

Licensing Program Analyst (LPA) Graham Gunby arrived unannounced on 02/18/2026 to complete and deliver findings to a complaint received on 09/09/2025. LPA met with Administrator, Carmen Balint and explained the purpose of the visit. Throughout the course of the investigation, the department conducted interviews and record reviews. Please continue to LIC9099C.. Unsubstantiated Allegation: Staff physically assulted a resident causing injury resulting in hospitalization On 09/06/2025, R1 was admitted to Sutter Roseville Medical Center for complaint of left foot pain. An MRI confirmed moderate second proximal phalangeal bone marrow edema and severe second phalangeal bone marrow edema suspicious for osteomyelitis. Doctors subsequently amputated R1’s left index toe. R1 reported that a caregiver, S2, intentionally hit the toe with a standing lift. No other information contained in the medical records indicates that R1’s toe wound resulted from an intentional impact with an object like a standing lift. Historically, R1 suffered from foot cellulitis related to their diabetes diagnosis. Prior to their hospitalization, R1 received regular wound care treatment from InnovAge for various preexisting pressure wounds to their left foot. There was no indication of a left index toe injury until 04/22/2025 when redness was observed on the top of R1’s left index toe; however, the toe injury was not concerning until an open wound was observed on 08/14/2025. S2 denied the allegation to the Rocklin Police Department and the Investigations Branch and stated that R1 often threatened to have them terminated. On 09/04/2025, S2 told facility Administration that R1 threatened to report them and tell lies that would “spread like wildfire.” S2 subsequently documented the interaction in a handwritten letter. No other residents reported similar allegations against S2. R2 claimed to have been close with R1 and R1 expressed their frustrations related to the facility. R2 indicated that R1 never mentioned any physical abuse by S2 or another caregiver. Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation 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 conducted and report provided. Allegation: Staff verbally abusing resident Interview conducted with staff member S1 indicated that staff members haven’t been heard being verbally abusive towards residents in care. R2 indicated that there are times when they have to elevate their voices due to residents not being able to hear (due to hearing loss) or understand the staff correctly. Interviews with R2 indicated that staff are helpful at all times and have not heard any staff verbally abusing residents in care. Allegation: Facility failed to meet reporting requirements LPA interviewed staff and reviewed facility information. Through interviews S1 stated when an incident occurs the staff writes a report and then sends the information to management. The management team reviews the information and creates an incident report. Administrator stated if needed they will send incident report into CCL. LPA reviewed incident reports sent into CCL and found facility is sending in incident reports throughout the year on incidents that have occurred with residents in care. The allegation is UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Feb 18, 2026 · control 59-AS-20250909171014

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Graham Gunby arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA met with Administrator, Carmen Balint, and explained the purpose of the visit. LPA and Administrator conducted a tour of the interior and exterior of the facility. Areas toured include but not limited to resident bedrooms, bathrooms, kitchen, common areas and backyard. LPA observed required furniture, and lighting throughout the residents' bedrooms and facility. LPA observed residents' bathrooms to be clean, sanitary, and in good repair. LPA observed food supplies of non-perishables for a minimum of seven (7) days and perishable foods for a minimum of two (2) days. Toxins and cleaning supplies are locked and inaccessible to residents in care. The hot water temperature was measured in the kitchen sink at 113.3 degrees Fahrenheit. LPA observed fire detectors and carbon monoxide alarms to be operable. The fire extinguisher is located in the kitchen and was last serviced on 09/30/25. LPA observed required Licensing posters posted in the entry of the facility. LPA observed medications to be locked and inaccessible to residents in care. LPA reviewed three (3) resident files. Resident files contained all required documentation. LPA reviewed three (3) staff records. Staff have all required documentation and first aid training. No deficiencies are being cited during today's inspection. Exit interview conducted and a copy of the report will be emailed to Administrator.the state’s words, verbatim · CDSS document, Jan 20, 2026

Type of visit: Required - 1 Year

LPA Hiratsuka, conducted this unannounced annual visit. This facility has six private resident rooms. One private room is to the right of the main entrance. The rest of the resident rooms and two common bathrooms are located to the left of the facility down a hallway. The entrance of the facility leads to an open floor plan that has the kitchen, dining, and sitting area. There is a locked storage closet for medications and records in the kitchen area. There locked laundry room and caregiver room in a nook area in the kitchen. The garage is only accessible from the outside and is used for storage. The backyard was inspected. There is a gate on both sides of the facility. -two staff records were reviewed -three resident records were reviewed -multiple topics were discussed The following shall be updated and submitted to Community Care Licensing by the end of the month: -LIC 500 facility personnel or staff schedule -LIC 610 emergency disaster plan -LIC 308 designation of administrative responsibility No citations were issuethe state’s words, verbatim · CDSS document, Jan 14, 2025

Type of visit: Required - 1 Year

On 12/14/2023 at 9:30 AM, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA met with staff and explained the purpose of the visit. LPA requested for staff to notify administrator, Carmenuta Balint, of LPA's presence at the facility. Administrator arrived at a later time. At 10:00 AM, LPA reviewed a total of four (4) resident files. Resident files contain signed admission agreements, physician's reports, appraisals, identification sheets, releases, and resident's rights. Medications are centrally stored, locked, and appear to be given per doctor order. LPA compared medications to those being given for four (4) residents and found no discrepancies. Facility is correctly using the Medication Administration Records (MAR). LPA reviewed a total of two (2) staff record. Staff has training in medications, first aid and CPR, and other various areas of care provision. At 10:30 AM, LPA and administrator toured the interior and exterior of the facility to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, residents' bedrooms, bathrooms, kitchen, garage, laundry room, and backyard. LPA observed required furniture, and lighting throughout the residents' bedrooms and facility. LPA observed residents' bathrooms to be clean, sanitary, and in good repair. LPA observed food supplies of non-perishables for a minimum of one (1) week and perishable foods for a minimum of two (2) days. Toxic and cleaning supplies locked and is inaccessible to residents in care. The hot water temperature was measured in the kitchen at 112 degrees Fahrenheit. First aid kit was completed. LPA observed fire detectors and carbon monoxide alarms to be operable. The fire extinguisher was last serviced on 11/1/2022. Fire drill was last conducted on 09/13/2023. LPA observed medications to be locked and inaccessible to residents in care. LPA observed required Licensing posters posted throughout the facility. No deficiencies being cited during today's inspection. Exit interview conducted and report provided.the state’s words, verbatim · CDSS document, Dec 14, 2023