045002773-5-17-2024-59-AS-KHOS-D5YKXN-20240606081748

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002773
Report Date: 05/16/2024
Date Signed: 05/17/2024 11:22:29 AM

Unsubstantiated

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
03/08/2024 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20240308094352

FACILITY NAME:	ROSELEAF OROVILLE		FACILITY NUMBER:	045002773
ADMINISTRATOR:	BINGHAM, DIANIA		FACILITY TYPE:	740
ADDRESS:	1900 20TH ST		TELEPHONE:	(530) 538-8200
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95965
CAPACITY:	60	CENSUS: 38	DATE:	05/16/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Jessica Owen - administrative assistant		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Staff did not meet resident's incontinence needs - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

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05/16/2024 09:45 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with administrative assistant Jessica Owen. COO Diania Bingham listened to the meeting via telephone call and gave permission for Ms. Owen to sign to receive the complaint findings. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA interviewed the COO and five staff. LPA reviewed the following documents: Admission agreement, Physicians report, care plan, care tracking sheet for 1 resident.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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-20240308094352

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: 05/16/2024

NARRATIVE

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Staff did not meet resident's incontinence needs - UNSUBSTANTIATED

It was reported that Resident 1 (R1) uses a condom catheter. On multiple occasions R1’s condom catheter slipped off, staff refused to help R1, and R1 urinated all over themselves.

LPA reviewed R1’s LIC602 Physician’s Report which states that R1 is incontinent of bowel and bladder, uses briefs, and is unable to care for their own toileting needs. R1’s Care Tracking Sheet states resident is full assist with all ADLs. Care tracking sheet instructions for toilet: Resident needs help with using the bathroom and transferring to and from wheelchair and toilet. Care Plan instructions: Provide assistance with bathing, dressing, hygiene, provide reminders and assist as needed for incontinence care. The care plan and care tracking sheet do not include the use of a condom catheter.

2 of 5 staff stated that some staff had complained about having to help R1 put the condom catheter back on. 3 of 5 staff stated that R1’s condom catheter slips off. 2 of 5 staff stated that R1 pulls the condom catheter off.

COO stated R1 does not have a medical need to use a condom catheter, it is their personal preference. It is a choice of comfort for R1 which is not mandated by R1’s doctor. COO stated that R1’s urologist stated that a condom catheter is not appropriate for R1 to use. No documentation was provided to LPA to fact check this statement.

It was determined that staff do provide assistance with R1’s condom catheter although the use of a condom catheter is not included in R1’s care plan. LPA is requesting the facility to update R1’s Care Plan to include the use of a condom catheter and request an exception for R1 to use a condom catheter. This allegation is unsubstantiated.

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.

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

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC9099 (FAS) - (06/04)

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