045002620-3-6-2023-59-AS-DGUE-CPNSYG-20230306131727

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 045002620
Report Date: 02/28/2023
Date Signed: 03/06/2023 01:17:42 PM

Document Has Been Signed on 03/06/2023 01:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME:	INN AT THE TERRACES, THE		FACILITY NUMBER:	045002620
ADMINISTRATOR:	KEENE, CLIFF		FACILITY TYPE:	740
ADDRESS:	2950 SIERRA SUNRISE TERRACE		TELEPHONE:	(530) 894-5429
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	99	CENSUS:	DATE:	02/28/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	CLIFF KEENE		TIME COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 02/28/23, Licensing Program Analyst Donna Gurriere conducted a case management visit to follow up on a substantiated complaint allegation of failure to seek timely medical attention and resident sustained serious injuries due to lack of care and supervision. LPA Gurriere met with Administrator Cliff Keene and explained the purpose of the visit. On September 15, 2022, the Department concluded a complaint investigation for allegations that Resident sustained serious injuries due to a lack of care and supervision and facility failed to seek timely medical attention. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation, including medical records. On March 22, 2022, at 2:59 p.m., Resident 1 (R1) was found on the floor of R1’s apartment after sustaining an unwitnessed fall and was transported to the hospital. A review of medical records revealed R1 sustained a closed fracture of R1’s right distal femur (noted “as consequence of the fall”) and had an unstageable, full thickness pressure wound on R1’s right buttock. R1 sustained healing abrasion on R1’s right elbow and left forearm and a deep tissue injury on R1’s left heel. The Wound Care Registered Nurse (RN) assessed and found R1’s wounds to include the healing properties/scabbing of the elbow and forearm abrasion consistent with wounds that are 1 to 2 days old. continued

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: INN AT THE TERRACES, THE	FACILITY NUMBER: 045002620
	VISIT DATE: 02/28/2023

NARRATIVE

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This Department determined staff neglected R1 by failing to supervise R1 appropriately and failing to check on R1 as needed per facility’s policy. The Department found staff were falsifying information on the Resident Meal Checklist. Staff marked R1 was present for breakfast, lunch and dinner on March 21, 2022. Due to the falsified records, staff did not check on R1 resulting in a delay of medical treatment for an unwitnessed fall.

Per facility key fob records, R1 entered their room on March 20, 2022, at 2:56 p.m. and R1 never left the room until discovered on March 22, 2022, at 2:59 p.m. Key fob records indicate the last request for exit was on March 19, 2022, 8:07 p.m., and 13 additional “Request for Exits,” between 9:18 a.m. and 9:42 p.m. that day, by either R1 or a staff member. Records show that R1 last opened the door to exit on March 19, 2022 at 8:07 pm, however, the Maintenance Director explained, this does not mean that R1 necessarily left the room, but rather could have opened the door as if to exit. Maintenance Director and staff stated that R1 tended to open the door and peek out, but not actually exit. On March 20, key fob records indicate “No registered Request to Exit for entire 24-hour period, and no registered Passage for R1 for an entire 24-hour period.” R1 sustained an unwitnessed fall in R1’s room during this time period. R1 was discovered in R1’s room on March 22, 2022, at 2:59 p.m. when staff smelled “a really rancid urine smell” coming from R1’s room, which prompted staff to check on R1. Staff discovered R1 lying on the ground on their left side in a pool of urine. When R1 was found, it was documented R1 was not at baseline and staff contacted 9-1-1.

R1 was admitted to the hospital and diagnosed with a broken bone, pressure injuries and abrasions. Paramedics and medical staff (nurse and doctor) provided statements to support that the injuries were 1-2 days old. Medical records reviewed shows blood work indicated R1 was incapacitated for at least 8 hours which is evidence that R1 sustained the pressure injuries as a result of lying in a position for a prolonged period of time.

continued

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: INN AT THE TERRACES, THE	FACILITY NUMBER: 045002620
	VISIT DATE: 02/28/2023

NARRATIVE

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The preponderance of evidence supports that R1 did not receive timely medical attention due to staff falsifying records which resulted in neglecting to check on R1.

The above allegations were substantiated on September 19, 2022, and deficiencies were cited for violating the following California Code of Regulations (CCR) Title 22:  
 
Section 87468.2(a)(8) Additional Personal Rights of Residents in Privately Operated Facilities: In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all the following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse.

Section 87464(1) Basic Services (f) Basic services shall at a minimum include:
Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code Section 1569.2(c).
An immediate civil penalty in the amount of $500 was issued for a violation of Section 87464(1), and the license was informed that an additional civil penalty was still being determined and may be assessed based on Health and Safety Code Section 1569.49.

The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. Per Welfare and Institutions Code Section 15610.67 defines serious bodily injury as “an injury involving extreme physical pain, substantial risk of or protracted loss or impairment of function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including, but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by R1 sustaining pressure injuries, abrasions, and a broken bone from an unwitnessed fall that required hospitalization. Medical records and statements further determined that R1 was incapacitated for a prolonged period of time in which R1 did not receive timely medical attention.

continued

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: INN AT THE TERRACES, THE	FACILITY NUMBER: 045002620
	VISIT DATE: 02/28/2023

NARRATIVE

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Today, 02/28/23, the Department will be issuing a civil penalty per Health and Safety Code Section 1569.49(f) in the amount of $10,000 for a violation the Department constitutes as a serious bodily injury. However, since an immediate civil penalty of $500 was previously issued on September 15, 2022, the amount of the civil penalty issued today will be $9500.
 
A copy of the LIC 421D was given to the facility representative. 
 
Exit interview conducted.  Appeal Rights provided.  A copy of the report issued.  Signature on these reports acknowledges receipt of these rights, found on page 2 of LIC 421D. 

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

LIC809 (FAS) - (06/04)

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