045002773-5-30-2023-59-AS-KHOS-CSJMV2-20230606095601

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002773
Report Date: 05/30/2023
Date Signed: 05/30/2023 01:48:51 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/27/2023 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 59-AS-20230227150136

FACILITY NAME:	ROSELEAF OROVILLE		FACILITY NUMBER:	045002773
ADMINISTRATOR:	FARMER, AMBER		FACILITY TYPE:	740
ADDRESS:	1900 20TH ST		TELEPHONE:	(530) 538-8200
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95965
CAPACITY:	60	CENSUS: 30	DATE:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	AMBER FARMER		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility staff do not provide adequate services to residents in care.
Residents call bells are not being provided in a timely manner.
Facility staff do not provide adequate supervision.

INVESTIGATION FINDINGS:

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Donna Gurriere, Licensing Program Analyst was in contact and met with Amber Farmer, Administrator to discuss the complaint allegations.

Facility staff do not provide adequate services to residents in care.

During the interview process, the administrator, six staff persons, one resident, and a regional center staff person were interviewed. Various documents were obtained and reviewed to include Physicians Reports, Admission Agreements, Appraisal and Needs, Medication Logs, resident logs, staffing telephone numbers and staff training documents.

continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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 59-AS-20230227150136

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: ROSELEAF OROVILLE	FACILITY NUMBER: 045002773
	VISIT DATE: 05/30/2023

NARRATIVE

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During the investigation process, it was indicated that two residents (Resident 1 and Resident 2) were not getting adequate services in being fed properly and with their bathing. It was reported that Resident 1 was fairly independent and could bathe himself prior to receiving hospice services. A review of the resident logs indicated that when the resident went on hospice, he received bed baths from the hospice nurse or the care staff. Also, in the resident’s logs it indicated that he was a good eater until he went on hospice and then after he went on hospice he ate very little or would refuse meals.

It was reported by staff that Resident 2 was very independent and generally did not want any assistance with feeding, which staff noted in the resident’s charting logs. Also, it was reported that the resident is difficult due to his diagnosis and that many times he would refuse to be fed or bathed. On 03/06/23 LPA Gurriere met with the resident; the resident was clean and sitting in bed, as he had recently been groomed and changed.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

Residents call bells are not being provided in a timely manner.

During the interview process, the administrator, six staff persons, one resident, and a regional center staff person were interviewed. Various documents were obtained and reviewed to include Physicians Reports, Admission Agreements, Appraisal and Needs, Medication Logs, resident logs, staffing telephone numbers and staff training documents.

Staff persons were interviewed, and they reported that they try to respond to the call bells within a few minutes. It was reported that if one care provider is aiding a resident and cannot respond, that care provider will radio for another care provider to answer the page. Overall, it was reported that staff respond to the residents in a timely manner.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 59-AS-20230227150136

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: ROSELEAF OROVILLE	FACILITY NUMBER: 045002773
	VISIT DATE: 05/30/2023

NARRATIVE

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Facility staff do not provide adequate supervision.

During the interview process, the administrator, six staff persons, one resident, and a regional center staff person were interviewed. Various documents were obtained and reviewed to include Physicians Reports, Admission Agreements, Appraisal and Needs, Medication Logs, resident logs, staffing telephone numbers and staff training documents.

During the investigation of the allegation, it was stated that a resident (Resident 3) has left the facility on his own several times. However, staff were interviewed, and they reported that the allegation is untrue. It was reported that the resident is very active in his movement and wants to walk throughout the facility each day and that the resident is taken out several times a week by his family to go on luncheons; however, that the resident has never left the facility unaccompanied.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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