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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002773
Report Date: 05/02/2024
Date Signed: 05/02/2024 11:16:57 AM

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
03/14/2024 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20240314101901
FACILITY NAME:ROSELEAF OROVILLEFACILITY NUMBER:
045002773
ADMINISTRATOR:BINGHAM, DIANIAFACILITY TYPE:
740
ADDRESS:1900 20TH STTELEPHONE:
(530) 538-8200
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY:60CENSUS: DATE:
05/02/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Diania Bingham - COOTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff did not transport resident in a safe manner - SUBSTANTIATED
Staff are not bathing a resident in care - SUBSTANTIATED
INVESTIGATION FINDINGS:
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05/02/2024 10:00 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with Jessica Owen administrative assistant, COO Diania Bingham listened to the delivery of the investigation results by phone and approved Ms, Owen to sign the report. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA interviewed the administrator and 3 staff Admission agreement, care plan, physician's report, ADL charting, Medication Administration Record (MAR), observation notes for March 2024 for 1 resident.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
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
Control Number 59-AS-20240314101901
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: ROSELEAF OROVILLE
FACILITY NUMBER: 045002773
VISIT DATE: 05/02/2024
NARRATIVE
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Staff did not transport resident in a safe manner – SUBSTANTIATED

It was reported that staff were transporting a wheelchair bound resident in the facility van to a medical appointment. When the van came to a stop, the resident fell out of the wheelchair because the resident did not have a seat belt on. RP stated they received a call from the driver, RP went to help but ultimately the fire department had to come and help get R1 back into their wheelchair. R1 sustained some bruising but no injury as a result.

LPA reviewed Resident 1 (R1)’s Physicians Report which states that R1 is non-ambulatory.

Care staff had no direct knowledge of the incident.

Administrator stated they did hear about the incident. When R1 was interviewed, they said they were strapped in but were unsure how the seatbelt came unlatched.

It was determined that staff did not ensure that R1 had a seatbelt on while being transported resulting in R1 falling out of their wheelchair in the facility van.

Continued on LIC812-C

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 59-AS-20240314101901
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: ROSELEAF OROVILLE
FACILITY NUMBER: 045002773
VISIT DATE: 05/02/2024
NARRATIVE
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Staff are not bathing a resident in care - SUBSTANTIATED

It was reported that a resident is not being bathed.

LPA reviewed R1’s Care plan which states that R1 is to shower on Monday, Wednesday, and Friday of each week. LPA reviewed Physician’s Report for R1 which states that R1 must be supervised while bathing and forgets to bathe. LPA reviewed Care Tracking Sheet for R1 which states the resident is full assist with all activities of daily living (ADLs). The ADL category Showers has instructions: Resident needs assistance with transfers into shower chair, resident also needs assistance with helping bathe. According to the Care Tracking Sheet during the month of March 2024 R1 was scheduled for 12 shower days. Resident had showers on 7 of the 12 scheduled shower days. On 5 of the scheduled shower days R1 was not showered with an outcome on “not completed.” LPA reviewed observation notes for the month of March 2024 for R1 and there were no notations of R1 refusing showers.

Staff interviews revealed that R1 complained that the staff would not go in his room to help him.

Administrator stated R1 refuses showers, if R1 is refusing, we can’t force him to get in the shower.

It was determined that R1 is not being bathed according to their care plan. This allegation is substantiated.

Based on interviews and evidence obtained during the investigation, 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 LIC9099D. Appeal rights were provided. Exit interview conducted and a copy of the report was provided to COO Diania Bingham.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 59-AS-20240314101901
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: ROSELEAF OROVILLE
FACILITY NUMBER: 045002773
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/16/2024
Section Cited
CCR
87468.2(a)(4)
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87468.2 (a)(4) Additional Personal Rights of Residents in Privately Operated Facilities (a) 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 of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are competent to meet their needs. This requirement was not met as evidenced by:
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Licensee agrees to conduct a staff training concerning the requirement to safely transport residents. Licensee shall submit the staff sign in sheet with dates and staff signatures as proof of correction.
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Based on interviews and document review it was determined that staff did not ensure that a seatbelt was placed on R1 prior to transport in the facility van which resulted in R1 falling out of their wheelchair. This poses a potential health and safety risk to residents in care.
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The proof of correction is to be received by LPA Knight by 05/16/2024.
Type B
05/16/2024
Section Cited
HSC
1569.2(c)
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Health and Safety Code section 1569.2(c) provides: (c) "Care and supervision" means the facility assumes responsibility for, or provides… ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. This requirement was not met as evidenced by:
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Licensee agrees to conduct a staff training concerning the requirement to assist residents with showers. Licensee shall submit the staff sign in sheet with dates and staff signatures as proof of correction. Additionally, licensee agrees to submit a plan for staff to follow specific to providing R1 assistance with showering and ensuring that R1 receives the required number of showers outlined in their care plan.
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Based on interviews and document review it was determined that staff did not ensure that Resident 1 is provided assistance in showering with the required number of showers as required in their care plan. This poses a potential health and safety risk to residents in care.
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The proof of correction is to be received by LPA Knight by 05/16/2024.
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: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC9099 (FAS) - (06/04)
Page: 4 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
03/14/2024 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20240314101901

FACILITY NAME:ROSELEAF OROVILLEFACILITY NUMBER:
045002773
ADMINISTRATOR:BINGHAM, DIANIAFACILITY TYPE:
740
ADDRESS:1900 20TH STTELEPHONE:
(530) 538-8200
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY:60CENSUS: DATE:
05/02/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Diania Bingham - COOTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
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Resident sustained an unexplained injury while in care - UNSUBSTANTIATED
Staff are not properly caring for resident's skin rash - UNSUBSTANTIATED
Staff are not giving water to residents in care - UNSUBSTANTIATED
INVESTIGATION FINDINGS:
1
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05/02/2024 10:00 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with Jessica Owen administrative assistant, COO Diania Bingham listened to the delivery of the investigation results by phone and approved Ms, Owen to sign the report. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA interviewed the administrator and 3 staff Admission agreement, care plan, physician's report, ADL charting, Medication Administration Record (MAR), observation notes for March 2024 for 1 resident.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 59-AS-20240314101901
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: ROSELEAF OROVILLE
FACILITY NUMBER: 045002773
VISIT DATE: 05/02/2024
NARRATIVE
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Resident sustained an unexplained injury while in care - UNSUBSTANTIATED

It was reported that a resident has a scrape on their buttocks and it is unknown how the resident got the injury. RP states that R1 a bed sore 3 years ago and it just stayed a dry spot.

LPA reviewed R1’s Physicians Report which states that R1 has a history of skin condition breakdown and needs help with care.

Staff stated that R1 has a very sore bottom but they would not call it a scrape.

Administrator stated they had no knowledge about the scrape on R1’s buttocks.

It was determined that R1 does not have a scrape on their buttocks but does a history of a previous pressure injury that has stayed as a dry spot, additionally R1 does have issues with rashes in the area. This is not an injury. This allegation is unsubstantiated.

Staff are not giving water to residents in care. - UNSUBSTANTIATED

It was reported that the residents are not given water at the facility.

On the day of the initial visit LPA observed staff rolling a cart through the facility offering water and lemonade to residents.

Administrator stated the facility has a hydration cart and do 2-hour rounds where staff goes in and changes the residents and checks on what they need, gives them water. The facility also offers coffee tea and water time at 10:00 am and 3:00 pm every day.

It was determined the facility does offer water and soft drinks to residents. This allegation is unsubstantiated.

Continued on LIC9099-C

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 59-AS-20240314101901
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: ROSELEAF OROVILLE
FACILITY NUMBER: 045002773
VISIT DATE: 05/02/2024
NARRATIVE
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Staff are not properly caring for resident's skin rash - UNSUBSTANTIATED

It was reported that a resident is supposed to have the cream placed on a rash after each bath/ shower and the staff are not putting the cream on the resident.

LPA reviewed R1’s Physicians Report which states that R! has a history of skin condition breakdown and needs help with care.



LPA reviewed R1’s MAR for the month of March 2024 which states that R1 was prescribed Calmoseptine External Ointment 0.44-20.6 % with instructions APPLY TO PERINEAL AREA AS NEEDED FOR REDNES /RASH/ EXCORIATION UNTIL CLEARED. This ointment was applied to R1 on 3/12/2024 and 03/18/2024 with an effective outcome noted. R1’s MAR includes Hydrocortisone External Ointment 2.5 % with instructions to apply to affected area of face/groin twice daily for 2 weeks, then one week off, repeat pattern as needed for flares or irritation. This ointment was applied twice daily from the dates of March 1 through March 22, 2024 with the exception of the following dates: 03/05/24 PM dose, 03/06/2024 through 03/07/2024 AM & PM doses, and 03/08/2024 AM dose were not dispensed.

Staff interviews revealed that R1 has lots of creams, ointments, barriers, most of the time R1 will let staff apply the creams.

Administrator stated R1 has a rash on their groin, the staff go in the morning to change him, they call the med tech who comes in and puts powder or cream on the rash.

It was determined that staff are applying the required creams to R1 as indicated in the Medication Administration Record (MAR). This allegation is unsubstantiated.

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

Exit interview conducted and a copy of the report was provided to COO Diania Bingham.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7