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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002696
Report Date: 07/12/2023
Date Signed: 07/12/2023 12:34:05 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/13/2023 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20230313141308
FACILITY NAME:TOWNSEND HOUSEFACILITY NUMBER:
045002696
ADMINISTRATOR:PASQUALE, CHABLISFACILITY TYPE:
740
ADDRESS:10 ILAHEE LNTELEPHONE:
(530) 342-4455
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:38CENSUS: 28DATE:
07/12/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Chablis PasqualeTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Resident's facility fees were increased without proper notice
INVESTIGATION FINDINGS:
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LPA Hiratsuka, conducted this visit to deliver the results of the investigation above.

LPA Hiratsuka investigated the allegation “Resident's facility fees were increased without proper notice.” LPA interviewed Administrator about the rate increase.

The resident in question had a change in condition. The administrator had several meetings with the resident's responsible parties and did the rate increase. CA Health and Safety Code Resident's facility fees were increased without proper notice. For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care.
The notice shall include a detailed explanation of the additional services to be provided at the
new level of care and an accompanying itemization of the charges.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/13/2023 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20230313141308

FACILITY NAME:TOWNSEND HOUSEFACILITY NUMBER:
045002696
ADMINISTRATOR:PASQUALE, CHABLISFACILITY TYPE:
740
ADDRESS:10 ILAHEE LNTELEPHONE:
(530) 342-4455
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:38CENSUS: 28DATE:
07/12/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Chablis PasqualeTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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1. Staff did not seek timely medical care for resident in care
2. Staff did not provide proper incontinence care to resident in care
3. Resident's mobility device are not readily accessible to resident in care
INVESTIGATION FINDINGS:
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LPA Hiratsuka, conducted this visit to deliver the results of the investigation above.

LPA Hiratsuka investigated the allegation “1. Staff did not seek timely medical care for resident in care
2. Staff did not provide proper incontinence care to resident in care, 3. Resident's mobility device are not readily accessible to resident in care."

1. The resident developed a temperature and was not sent to the hospital until a day or two after developing the temperature. Resident has a history of urinary tract infections. The facility staff were in touch with home health and the doctor prior to the decision of sending the resident to the hospital. The resident was not admitted to the hospital. What cannot be proved or disproved is when the resident should've been sent to the hospital because it cannot be determined when the symptoms increased to the point to send the resident to the hospital.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 59-AS-20230313141308
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: TOWNSEND HOUSE
FACILITY NUMBER: 045002696
VISIT DATE: 07/12/2023
NARRATIVE
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2. LPA interviewed resident and a couple of staff. Resident stated there's no issue with care but the catheter has leaked a couple of times and came apart a couple of times. Staff stated resident wears a catheter and has a habit of disconnecting it. LPA cannot determine if the staff are not monitoring the resident enough to prevent the catheter issues.

3. The resident has a wheelchair and the complainant stated there have been several times that things were put on the wheelchair preventing the resident from using it. LPA interviewed resident and the resident stated they have had no issues with the chair not being available. Staff stated that things have been found on the chair and the resident has told them to put things on there as well. LPA cannot prove or disprove the issue because each side has their own version of events.

Due to the information gathered, LPA cannot determine the allegations 1. Staff did not seek timely medical care for resident in care; 2. Staff did not provide proper incontinence care to resident in care; 3. Resident's mobility device are not readily accessible to resident in care.. LPA finds allegation to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 59-AS-20230313141308
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TOWNSEND HOUSE
FACILITY NUMBER: 045002696
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2023
Section Cited
HSC
1569.657(a)
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Rate increase due to change in level of resident care; notice. For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing
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By 08/11/2023, the licensee shall submit in writing how they shall ensure all rate increases due to level of care are implemented correctly.
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 services at the new level of care. The notice shall include a detailed explanation of the additional .services to be provided at the new level of care and an accompanying itemization of the charges.

cont. below
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Type B
07/12/2023
Section Cited
HSC
1569.657(a)
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not a new citation. Continued from above. This requirement is not met as evidenced by: Based on LPA's interview the increase was not done correctly. This does not pose an immediate risk to residents
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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: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 59-AS-20230313141308
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: TOWNSEND HOUSE
FACILITY NUMBER: 045002696
VISIT DATE: 07/12/2023
NARRATIVE
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The administrator did not do the correct way to increase the rate due to level of care. She had the meetings but did not follow up the increase properly in writing.


Based on the above, the allegation is substantiated.

Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code. Failure to correct shall result in civil penalties. appeal rights left
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/13/2023 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20230313141308

FACILITY NAME:TOWNSEND HOUSEFACILITY NUMBER:
045002696
ADMINISTRATOR:PASQUALE, CHABLISFACILITY TYPE:
740
ADDRESS:10 ILAHEE LNTELEPHONE:
(530) 342-4455
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:38CENSUS: 28DATE:
07/12/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Chablis PasqualeTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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3
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4. Staff are not providing proper medication assistance to resident in care
5. Staff did not provide proper shower assistance to resident in care
6. Resident in care did not have access to his pendant
INVESTIGATION FINDINGS:
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LPA Hiratsuka, conducted this visit to deliver the results of the investigation above.

LPA Hiratsuka investigated the allegation “4. Staff are not providing proper medication assistance to resident in care; 5. Staff did not provide proper shower assistance to resident in care; 6. Resident in care did not have access to his pendant.

4. LPA interviewed resident. Resident stated they put medication into apple sauce without telling staff because the resident likes it that way. The resident also stated they get their medication on time all the time. Because the resident stated they put the medication into the applesauce themself it's not a violation. LPA suggested to Administrator to notify the doctor that the resident does this sometimes and to get approval. Medication record review shows the medications are given on time and are signed when they are given.
Based on the above the allegation is unfounded.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 59-AS-20230313141308
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: TOWNSEND HOUSE
FACILITY NUMBER: 045002696
VISIT DATE: 07/12/2023
NARRATIVE
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5. LPA interviewed the resident in question. Resident stated they refuse to take a shower on their own. The resident does get one when requested. The resident also stated there has been no issue of staff leaving theme alone while being bathed. Based on the interview the allegation is unfounded.

6. LPA interviewed the resident. Resident stated the pendant is always worn except when they chose to have it put on a table or somewhere else. Resident stated they have no issues getting assistance when requested. Based on the interview the allegation is unfounded.


“This agency has investigated the complaint alleging; 4. Staff are not providing proper medication assistance to resident in care; 5. Staff did not provide proper shower assistance to resident in care; 6. Resident in care did not have access to his pendant. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis."
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7