045002773-7-15-2022-25-AS-KHOS-CN8LVE-20230119080523

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002773
Report Date: 07/15/2022
Date Signed: 07/15/2022 11:49:17 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
07/13/2022 and conducted by Evaluator Jaclyn Avila

COMPLAINT CONTROL NUMBER: 25-AS-20220713105249

FACILITY NAME:	ROSELEAF OROVILLE		FACILITY NUMBER:	045002773
ADMINISTRATOR:	BROWN, TERRY L		FACILITY TYPE:	740
ADDRESS:	1900 20TH ST		TELEPHONE:	(530) 538-8200
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95965
CAPACITY:	60	CENSUS: 36	DATE:	07/15/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Crystal Cumminskey, Lead MT		TIME COMPLETED:	11:59 PM

ALLEGATION(S):

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Facility temperature is too hot
Facility refusing visitors

INVESTIGATION FINDINGS:

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On 07/15/2022, Licensing Program Analyst (LPA) Jaclyn Avila conducted an announced complaint investigation visit regarding the above allegations, and Crystal Cumminskey, Lead MT. 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 ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 LPA was not screened at the front door.

This Department has conducted an investigation into the above listed allegations and found them to be substantiated. During an onsite visit the Department utilized a infrared thermometer gun and found that the temperature in room #4 at 3:55 PM to be 88 degress F. Laudry room was 94 degrees F, Kitchen was 94 degrees F, Room #8 was 88 degrees F at 4:29 PM. During the inspection residents complained of the heat. Outside weather at this time was 100 degrees F.

Cont'd on LIC 9099C

Substantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn Avila	TELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

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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Control Number 25-AS-20220713105249

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 OROVILLE	FACILITY NUMBER: 045002773
	VISIT DATE: 07/15/2022

NARRATIVE

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Upon the Department's arrival at approximately 9:45 AM, LPA observed a sign on the front door of the facility that read "No visitors at this time due to Covid. Exceptions are Medical Personnel Only." LPA attempted to open the door to the entrance of the facility and it was locked. LPA utilized the door bell to summon staff.

Staff interviews revealed that residents have not been allowed to have visitors since 6/24/2022. Staff were also instructed that if families wanted to take residents out of the facility they weren't allowed to bring them back. Residents have only been permitted to have visitation through windows. While the LPA was on site the facility received a call from a family member stating they received a call that medications were delivered but no one was answering the door so they were left outside. Staff then went outside and retrieved the residents medication.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.

The following deficiencies were cited per Title 22 of the California Code of Regulation (See LIC 9099D). Appeal Rights were explained and provided to the facility representative listed above and an Exit Interview was conducted. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn Avila	TELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20220713105249

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 OROVILLE	FACILITY NUMBER: 045002773
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/15/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/15/2022 Section Cited CCR 87468.1(a)(11)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities -(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice	1 2 3 4 5 6 7	Licensee agrees to read all PINS from 2021-2022 as well as regulation 87468.1 regarding residents rights to visitors. Licensee agrees to remove the sign from the front door and permit visitors immediatly. Licensee will provided letter of understanding regarding the PINS and regulation 87468.1 within 24 hours to LPA via e-mail
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based upon observation and interview the Licensee failed to allow 36 of 36 residents in care their right to visitors. This poses an immediate Health, Safety and/or Personal Rights risk to residents in care.	8 9 10 11 12 13 14
Type A 07/16/2022 Section Cited CCR 87303(b)(2)	1 2 3 4 5 6 7	87303 Maintenance and Operation(b) A comfortable temperature for residents shall be maintained at all times.(2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature.	1 2 3 4 5 6 7	Licensee agrees to maintain the temperature between 78-85 degrees F or in extreme heat aka 100 degrees F to 30 degrees F less than the outside temperatur. Licensee agrees to place wall mounted bulb thermometers in every resident room, hallway and community area within the next 24 hours and provide daily readings to LPA for the next two weeks.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based upon observation and interview the Licensee failed to provide a comfortable temperature to residents, This poses an immediate Health, Safety and/or Personal Rights risk to residents in care.	8 9 10 11 12 13 14

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: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn Avila	TELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

LIC9099 (FAS) - (06/04)

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