045002445-9-30-2020-25-AS-RLBN-BTYMGV-20201001093631

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002445
Report Date: 09/29/2020
Date Signed: 09/30/2020 01:57:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/26/2020 and conducted by Evaluator Jaclyn Avila

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20200326153949

FACILITY NAME:	ROSELEAF GARDENS		FACILITY NUMBER:	045002445
ADMINISTRATOR:	KUPERMAN, FLORIE		FACILITY TYPE:	740
ADDRESS:	2770 SIERRA LADERA LANE		TELEPHONE:	(530) 895-0800
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	56	CENSUS: 38	DATE:	09/29/2020
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Florie Kuperman, Administrator		TIME COMPLETED:	09:53 AM

ALLEGATION(S):

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Facility staff does not change resident’s briefs
Resident sustained pressure sores while in care

INVESTIGATION FINDINGS:

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LPA Jaclyn Avila delivered complaint findings to Administrator via phone. Findings are delivered via telephone due to COVID-19 and pre-cautionary measures. LPA discussed the purpose of the call and the elements of the allegation(s) with Florie Kuperman, Administrator.
On 3/26/2020, California Department of Social Services Community Care Licensing, received a complaint alleging the Facility staff does not change resident’s briefs and a resident sustained pressure sores while in care. This department has investigated the allegation and the following are the findings: This department reviewed documents related to the allegations, conducted interviews and found the allegations to be unsubstantiated. This department learned through interviews that the resident’s condition did not become a restricted health care condition and resolved. Interviews revealed issues with brief changes were addressed and the care plan is being followed. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
No citations issued on today’s date. An exit interview was conducted with Administrator via telephone and a copy of this report will be provided to the facility via email. Two copies will be sent to the facility, 1 is to be signed and returned to CCL and the other copy is to be retained by the facility.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaclyn Avila	TELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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