045002775-8-6-2024-59-AS-KHOS-D8AQXQ-20240819123355

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002775
Report Date: 08/06/2024
Date Signed: 08/06/2024 09:33:38 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
05/03/2024 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 59-AS-20240503152347

FACILITY NAME:	ROSELEAF GARDENS		FACILITY NUMBER:	045002775
ADMINISTRATOR:	BINGHAM, DIANIA		FACILITY TYPE:	740
ADDRESS:	2770 SIERRA LADERA		TELEPHONE:	(530) 895-0800
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	56	CENSUS: 39	DATE:	08/06/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	MICHELLE LONG		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff are overmedicating resident in care.
Staff did not report incident(s) involving resident as necessary.
Facility does not have sufficient staffing to meet the needs of resident(s) in care.
Administrator/designee is not present at the facility a sufficient amount of time.
Staff do not ensure that resident has a sufficient quantity of food/liquids while in care.

INVESTIGATION FINDINGS:

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On 08/06/24 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 05/03/24. LPA Gurriere met with Michelle Long, Administrator Assistant and explained the purpose of the visit.

Staff are overmedicating resident in care.

During the interview process, the assistant administrator, two hospice nurses and three staff persons were interviewed. The residents were not interviewed due to their dementia status. In addition, the following documents were obtained and reviewed: Physician’s Report, Medication Administration Records (MARs), Daily Care Logs, Admission Agreement, staff work schedules, and staff telephone numbers.

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: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

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 4

Control Number 59-AS-20240503152347

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: 08/06/2024

NARRATIVE

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During the investigative process, it was indicated and verified that the resident (Resident 1) could not determine, per the physician’s order that she could indicate when she needed a Pro Re Nata (PRN). The physician ordered that the resident take Lorazepam and Phenobarbital on an “as needed basis” for anxiety. Staff did utilize the PRN order and stated that they did contact the on-call hospice nurse to get permission to give additional dosage; however, documentation could not be provided to support that the staff did call the hospice nurse when giving the PRN. It could not be proven one way or the other if the staff were over medicating the resident in care.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the above finding is Unsubstantiated.

Note: The regulations clearly state to record the date and time of each contact with the physician. In this case the staff were to contact the hospice nurse prior to giving the resident the PRN for Lorazepam and Phenobarbital, provide the date and time of each contact with the physician (hospice) and the physician’s (hospice) directions, were to be documented and maintained in the resident’s facility record. A separate citation will be given on an LIC 809 document indicating that the staff did not document when the hospice nurse was contacted to provide the resident with the PRN.

Staff did not report incident(s) involving resident as necessary.

During the interview process, the assistant administrator, two hospice nurses and three staff persons were interviewed. The residents were not interviewed due to their dementia status. In addition, the following documents were obtained and reviewed: Physician’s Report, Medication Administration Records (MARs), Daily Care Logs, Admission Agreement, staff work schedules, and staff telephone numbers.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20240503152347

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: 08/06/2024

NARRATIVE

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During the investigation, it was reported that the resident (Resident 1) may have suffered a fall and that it was not reported to the family members or the licensing agency. It was stated that the resident may have fallen; however, when interviewing staff, they indicated that they were not knowledgeable about a fall and if the resident did fall, it would have been reported to the family and to licensing, as required.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the above finding is Unsubstantiated.

Facility does not have sufficient staffing to meet the needs of resident(s) in care.
During the interview process, the assistant administrator, two hospice nurses and three staff persons were interviewed. The residents were not interviewed due to their dementia status. As mentioned, the staff work schedules were reviewed.

During the investigation, it was determined that for the most part there is sufficient staffing in that staff reported that there are three care providers and one medication technician that work the floor daily. It was also reported that the assistant administrator is available to provide support. Staff indicated that all Activities of Daily Living (ADLs) were being provided to include toileting, transferring, bathing, dressing, escorting to meals, medication administration, etc.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the above finding is Unsubstantiated.

Administrator/designee is not present at the facility a sufficient amount of time.
During the interview process, the assistant administrator, two hospice nurses and three staff persons were interviewed. The residents were not interviewed due to their dementia status.

During the investigation process, as mentioned the assistant administrator, hospice nurse and staff were interviewed. It was reported by the assistant administrator that she works weekly and at times on Saturdays. The staff indicated that the assistant administrator is available at the facility during the work week to assist in meeting the needs of the residents. The hospice nurse stated that she generally works with the Resident Care Coordinator and that he is available.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the above finding is Unsubstantiated.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 59-AS-20240503152347

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: 08/06/2024

NARRATIVE

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Staff do not ensure that resident has a sufficient quantity of food/liquids while in care.

During the interview process, the assistant administrator, two hospice nurses and three staff persons were interviewed. The residents were not interviewed due to their dementia status. In addition, the following documents were obtained and reviewed: Physician’s Report, Medication Administration Records (MARs), Daily Care Logs, Admission Agreement, staff work schedules, and staff telephone numbers.

During the investigation, the resident’s (Resident 1) Daily Care Logs were reviewed and there was a clear indication that the resident was eating and drinking throughout the day. Towards the end of her hospice services, the resident was receiving pureed food. All staff indicated that they felt that the resident was eating and drinking except for when she was sleeping or on hospice care and could no longer swallow.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the above finding is Unsubstantiated.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

LIC9099 (FAS) - (06/04)

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