045002445-4-22-2021-25-AS-RLBN-C2CNS7-20210423104237

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002445
Report Date: 04/22/2021
Date Signed: 04/22/2021 01:24:31 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 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
08/19/2020 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 25-AS-20200819115459

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:	0	CENSUS: 0	DATE:	04/22/2021
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Florie Kuperman, administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Lack of care/supervision: Resident 1 (R1) eloped and was outside of the facility in the garden area for more than two hours due to staff’s lack of care and supervision.

Lack of care/supervision: R1 sustained blisters to their feet and suffered heat exhaustion due to the staffs lack of care and supervision.

INVESTIGATION FINDINGS:

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4/22/2021 12:15 PM Licensing Program Analyst (LPA) Rebecca Knight made an unannounced visit to the facility and met with administrator Florie Kuperman. The purpose of the visit was to deliver findings on an investigation that was conducted by Department of Social Services Community Care Licensing Investigations Branch for a complaint that was received on August 19, 2020. Before entering the facility, LPA took her temperature which registered within normal range. LPA donned appropriate PPE. Upon entrance LPA met with Administrator Flore Kuperman. LPA Knight explained the reason for the visit.

Allegation: Lack of care/supervision: Resident 1 (R1) eloped and was outside of the facility in the garden area for more than two hours due to staff’s lack of care and supervision. - SUBSTANTIATED

Finding: Continued on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2021

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 4

Control Number 25-AS-20200819115459

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: ROSELEAF GARDENS	FACILITY NUMBER: 045002445
	VISIT DATE: 04/22/2021

NARRATIVE

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Staff 1 (S1), said they saw R1 in the facility dining room at approximately 1300 hours before S1 went on break. Staff 2 (S2) said it was very hot that day (08-15-2020) and when they went outside, they felt like they could not be out for five minutes. S2 found R1 outside at approximately 1415 hours, standing in the bushes barefoot. S2 said they were not looking for R1, they were simply taking a shortcut from one building to another and accidently came across R1 standing in the bushes. S2 saw R1 outside multiple times that day but couldn't remember how many times or for how long. The facility's video system does not show the courtyard where R1 was found barefoot. The only camera (there are several outside) that worked is pointed at the facility's front door, so the staff have no way of seeing who is in the back-garden area without physically checking it. Doctor from the local hospital said based on their medical exam of R1, R1 was outside for two hours because when R1 arrived at the ER their temperature was 101.4 degrees Fahrenheit at 1524 hours, when R1 arrived in the ER. R1 was outside for over one hour and fifteen minutes.

Based on the interviews and evidence obtained, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D. Appeal rights were provided, and an exit interview conducted.

Continued on LIC9099-C

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2021

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20200819115459

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: ROSELEAF GARDENS	FACILITY NUMBER: 045002445
	VISIT DATE: 04/22/2021

NARRATIVE

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Allegation: Lack of care/supervision: R1 sustained blisters to their feet and suffered heat exhaustion due to the staffs lack of care and supervision. - SUBSTANTIATED

According to R1's medical records, R1 was diagnosed with dehydration, dementia, heat stroke and sunstroke, and partial thickness bums on both feet with 2nd degree bums on the left foot, and mild acute kidney injury with hyperkalemia (higher than normal potassium level in the blood). R1's final diagnoses were hyperthermia associated with heat, acute kidney injury, and blisters with epidermal loss due to burn (2nd degree) of foot.

Civil penalties assessed today in the amount of $500.00.

The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. This incident is currently under review and a future civil penalty may apply based on 1569.49(f) H&S. Failure to correct the deficiencies may also result in civil penalties.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 25-AS-20200819115459

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: ROSELEAF GARDENS	FACILITY NUMBER: 045002445
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/22/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/22/2021 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411(a) Personnel Requirements – General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The licensee to provide a detailed plan explaining how they will ensure facility staff are competent and aware of how to properly provide care and supervision to residents during hot weather. This plan shall be completed within one week.
	8 9 10 11 12 13 14	Based on the Investigator’s interviews of staff it was determined that staff did not provide adequate care and supervision to R1 which resulted in R1 eloping to the outside garden area of the facility during a heat wave for a prolonged period which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	Proof of completion shall be sent to the licensing agency by 4/29/2021.
Type A 04/22/2021 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411(a) Personnel Requirements – General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The licensee to provide training to all facility staff to ensure that they know how to properly provide care and supervision to residents during hot weather. This training shall be completed within one week. Additional civil penalties may apply.
	8 9 10 11 12 13 14	Based on the Investigator’s interviews of staff it was determined that staff did not provide adequate care and supervision to R1 which resulted in R1 sustaining blisters to their feet and suffering from heat exhaustion which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	Proof of completion shall be sent to the licensing agency by 4/29/2021.

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: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2021

LIC9099 (FAS) - (06/04)

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