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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002224
Report Date: 11/21/2022
Date Signed: 11/21/2022 02:36:17 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/22/2022 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 25-AS-20220422091749
FACILITY NAME:ALMOND BLOSSOM SENIOR CAREFACILITY NUMBER:
045002224
ADMINISTRATOR:RAMOS, EDUVIJESFACILITY TYPE:
740
ADDRESS:1036 BLACKMUIR COURTTELEPHONE:
(530) 342-1813
CITY:CHICOSTATE: CAZIP CODE:
95926
CAPACITY:6CENSUS: 6DATE:
11/21/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kathrine CartwrightTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Criminal Record Clearance
Resident's needs are not met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 11/21/22 to deliver complaint findings. LPA met with Katherine Cartwight and Emily Lanser and explained the purpose of the visit. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA completed a facility risk assessment upon arrival. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility.

The department reviewed client/resident records and conducted interviews.
The department finds that the allegations cited above are substantiated.

Records reviews and interviews on 4/5/22 another LPA cited and assessessed civil penalties for staff not finger print cleared and associated.Therefore while this allegation is substantiated it is not a repeat
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
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 6
Control Number 25-AS-20220422091749
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: ALMOND BLOSSOM SENIOR CARE
FACILITY NUMBER: 045002224
VISIT DATE: 11/21/2022
NARRATIVE
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** Amended** violation.

Records reviews for R1, R2 and R3 and interviews conducted on 11/21/22 found that generally resident care is meeting the needs of residents. However, on 2/27/22 at approximately 5:30 AM, R1 had an unwitessed fall. R1 stated they were fine though they had pain. Resident requested emergency care not be called as they preferred to take Tylenol. R1's responsible party was contacted and agreed with the care. LPA interviewed Emily Lanser and she stated reported that on 2/28/22, Emily spoke with R1's physician who recommended continued use of Tylenol as needed and seek medical care if R1's condition worsened.
On 3/1/22, R1 reported continued pain and had limited mobility. Transport to emergency assessment was arranged. At admission, R1 was found to have pelvis fracture.
Katherine Cartwright stated the facility policy is to call 9-1-1 for unwitnessed falls with injuries and in this case due to R1's and R1's POA this was delayed.
As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.
Report reviewed with Katherine Cartwright. Copy of this report and appeal rights provided.

On 12/15/22, LPA Mknelly returned to issue civil penalties for R1's fall/ fracture response of 2/27/22- 3/1/22. At the time of the citation, LPA requested written documentation from R1's physician's office of the facility's reported contact on 2/28/22. The requested document was unavailable from the Dr.. Therefore, the failure to seek medical attention for R1 left R1 with a untreated injury.
An immediate civil penalty in the amount of $500.00 is to be assessed for a resident sustaining a serious bodily injury while in care at this facility. As a result of resident’s injury, the violation warrants a civil penalty assessment based on health and safety code 1569.49. At this time, the civil penalty assessment is under review. LPA will return at a future date to assess a civil penalty if warranted.

Amended report reviewed with Administrator . Copy of this report, civil penalty and appeal rights provided.

SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 25-AS-20220422091749
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: ALMOND BLOSSOM SENIOR CARE
FACILITY NUMBER: 045002224
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
11/22/2022
Section Cited
CCR
87645(g)
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87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health...
This requirement was not met as evidenced by records and interviews that R1'
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Licensee will submit a statement of understanding of this requirement by the POC date of 11/22/22.
Licensee will submit proof of retraining of all staff on this requirement by 11/28/22.
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immediate medical care needs were not identified and cared for by medical personnel between 2/27/22 and 2/28/22.
This posed a risk to the resident.
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Civil penalty in the amount of $500.00 is to be assessed for a resident sustaining a serious bodily injury while in care at this facility, on 12/15/22 and appeal rights provided.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/22/2022 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 25-AS-20220422091749

FACILITY NAME:ALMOND BLOSSOM SENIOR CAREFACILITY NUMBER:
045002224
ADMINISTRATOR:RAMOS, EDUVIJESFACILITY TYPE:
740
ADDRESS:1036 BLACKMUIR COURTTELEPHONE:
(530) 342-1813
CITY:CHICOSTATE: CAZIP CODE:
95926
CAPACITY:6CENSUS: 6DATE:
11/21/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kathrine CartwrightTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff handled resident roughly
Staff do not assist residents with incontinence needs
Staff do not serve nutritious food
INVESTIGATION FINDINGS:
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On 11/21/22, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with clinical staff. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms.Upon arrival, completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened with temperature at the facility.

LPA conducted records review and extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.

Neither records, interviews nor LPA's limited observations uncovered evidence that staff handled resident roughly. The resident is unable to accurately report historical information.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 25-AS-20220422091749
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: ALMOND BLOSSOM SENIOR CARE
FACILITY NUMBER: 045002224
VISIT DATE: 11/21/2022
NARRATIVE
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Resident record reviews, interviews and inspections found the residents to be clean dry and odor free, therefore there is not additional evidence to support the allegation that staff do not assist residents with incontinence needs
Inspections of food on hand and resident dietary needs do not support that staff do not serve nutritious food.

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - 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.

Exit interview with administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/22/2022 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 25-AS-20220422091749

FACILITY NAME:ALMOND BLOSSOM SENIOR CAREFACILITY NUMBER:
045002224
ADMINISTRATOR:RAMOS, EDUVIJESFACILITY TYPE:
740
ADDRESS:1036 BLACKMUIR COURTTELEPHONE:
(530) 342-1813
CITY:CHICOSTATE: CAZIP CODE:
95926
CAPACITY:6CENSUS: 6DATE:
11/21/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kathrine CartwrightTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff not trained properly
Staff do not document medical care
Activies are not being provided to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 10/15/21 to provide complaint findings. LPA met with staff and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Upon arrival LPA completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility.

LPAs reviewed resident records, facility records and conducted interviews.
The department finds that facility met Tittle 22 requirements.
Training records showed required training, facility does not provide medical care and would not document such and facility employs a activities director- they and caregivers offer activites.
This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted and report provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6