<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 092700840
Report Date: 07/29/2021
Date Signed: 07/29/2021 02:17:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/03/2020 and conducted by Evaluator Michael Smith
COMPLAINT CONTROL NUMBER: 27-AS-20201103143012
FACILITY NAME:VILLAGE OAKS SENIOR CARE, LLCFACILITY NUMBER:
092700840
ADMINISTRATOR:FOULK, BENJAMIN L.FACILITY TYPE:
740
ADDRESS:1011 ST. ANDREWS DRIVETELEPHONE:
(916) 293-1981
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:15CENSUS: 10DATE:
07/29/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tanya GarciaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident developed pressure injuries while in care.
Resident's toileting needs are not being met.
Staff rough-handle resident in care.
Facility is malodorous.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Prior to entering the facility, LPA Smith spoke with staff to pre-screen that the facility is COVID free. Analyst also self-screened for having no known symptoms or exposure. Analyst followed facility's screening protocols, wore an N-95 respirator and maintained distance during the visit. LPA Smith conducted an unannounced complaint visit and met with Tanya Garcia.

Allegations: Resident developed pressure injuries while in care.
R1 was hospice when the complaint came in. Green Valley Hospice was the provider and notes from 10/25/20- "No pain or discomfort at this time. Peri and coccyx drg intact. No other skin issues." 11/25/20 indicate a "foul smell on coccyx area wound & drainage". 12/7/20- "No new skin issues noted. Dry". Physicians Orders 12/2/20- Coccyx - Cleanse with wound cleaner, pat dry, apply opticel to open area, cover with hydrocolloid or optifoam, or gentle sacrum 3 times a week or prn if soiled or dislodged". R1 while on hospice, may have or developed coccyx wounds. These issues were being actively addressed by the hospice care agency and were being treated and monitored by the hospice agency. R1 was on hospice and the ulcers are being actively treated and monitored. Based on this, this allegation is UNSUBSTANTIATED.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Michael Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
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 2
Control Number 27-AS-20201103143012
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: VILLAGE OAKS SENIOR CARE, LLC
FACILITY NUMBER: 092700840
VISIT DATE: 07/29/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Resident's toileting needs are not being met.
Visual inspection of every occupied room (10) and none were malodorous and all appeared to be clean and tidy. All residents rooms had portable johns that were clean at the time of inspection. Staff stated that residents toileting needs are addressed on an as needed basis. Based on this, this allegation is UNSUBSTANTIATED.

Staff rough-handle resident in care.
Complaint states that an employee allegedly "mistreats" residents by pushing them to hurry them to bed. Interviews of residents and family members. Family members state that residents have never reported being pushed or rough handled. Family had nothing but praise for the care facility and the care that they have been providing. Family has no complaints about the facility. Based on this, the allegation is UNSUBSTANTIATED.
Facility is malodorous.
Visual and olfactory of every occupied room (10) and none were malodorous. All appeared to be clean and tidy. Staff stated that the only time the room would be malodorous would be if the occupant had used the portable john or had a recent bowel movement in their briefs at which time staff would immediately address the source of the odor. Based on this, this allegation is UNSUBSTANTIATED.

As a result of this investigation, LPA finds the allegation that resident developed pressure injuries while in care, residents toileting needs are not being met, staff rough-handle resident in care and facility is malodorous to be UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means 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.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Michael Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2