045002775-10-10-2023-59-AS-KHOS-CWPN6R-20231017101133

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002775
Report Date: 10/10/2023
Date Signed: 10/10/2023 11:45:06 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
04/21/2023 and conducted by Evaluator Donna Gurriere

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230421145534

FACILITY NAME:	ROSELEAF GARDENS		FACILITY NUMBER:	045002775
ADMINISTRATOR:	SMITH, AUDRE		FACILITY TYPE:	740
ADDRESS:	2770 SIERRA LADERA		TELEPHONE:	(530) 895-0800
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	56	CENSUS: 38	DATE:	10/10/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	STACEY BAXTER		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not provide residents with an adequate amount of food.
Staff did not assist residents with self-administration of medication.

INVESTIGATION FINDINGS:

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On 10/10/23, Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 04/21/23. LPA Gurriere met with Stacey Baxter, Assistant Administrator, and explained the purpose of the visit.

Staff did not provide residents with an adequate amount of food.

During the interview process, the assistant administrator and four staff persons were interviewed. Three other staff persons were contacted; however, they did not return the call. The resident (Resident 1) was not interviewed as she is on hospice care and is too advanced in her hospice journey to be interviewed. Documents were received to include the residents Physician Report, Admission Agreement, medications list, care tracking sheet and weight records.

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: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

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-20230421145534

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 GARDENS	FACILITY NUMBER: 045002775
	VISIT DATE: 10/10/2023

NARRATIVE

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During the investigation, on 05/02/23 Donna Gurriere, LPA conducted a walk through of the kitchen to determine if there was an adequate amount of food. During the visit, it was noted that the cook was providing lunch to include a large slice of chicken, macaroni and cheese and cold slaw. The food was prepared, and appropriate amounts of portions were provided. The residents were having vanilla shakes for dessert. Staff were interviewed and all staff reported that they have observed and felt that there was an appropriate amount of food that was being provided daily to include three meals a day and snacks. Additionally, it was reported that the facility always has additional food to include second helpings, left over foods and anytime meals of grill cheese sandwiches, peanut butter and jelly sandwiches, crackers, etc. It was reported that throughout the day residents are offered snacks to include bananas, pudding, left over desserts and fruits.

A resident’s weight records were reviewed, and the records indicated that during the time of January through June 2023, the resident’s weight fluctuated by approximately five pounds. In June 2023 the resident was placed in hospice care and her weight has gone down by 10 pounds, which is understandable since it was reported that the resident is on hospice and at times refuses to eat meals.

Due to the information above, CCL finds the allegation to be Unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Staff did not assist residents with self-administration of medication.
During the interview process, the assistant administrator and four staff persons were interviewed. Three other staff persons were contacted; however, they did not return the call. The resident was not interviewed as she is on hospice care and is too advanced in her hospice journey to be interviewed. Documents were received to include the residents Physician Report, Admission Agreement, medications list, care tracking sheet and weight records.

During the investigation, the staff persons were interviewed, and reported that staff do assist the residents with self-administration of medication. Staff advised that when the medication technician passes the medication to the residents, the medication technicians are to standby the resident to ensure that the resident takes and swallows the medication.

Due to the information above, CCL finds the allegation to be Unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

LIC9099 (FAS) - (06/04)

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