097004177-3-23-2022-27-AS-LMUZ-CCSRFK-20220323125913

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 097004177
Report Date: 03/23/2022
Date Signed: 03/23/2022 09:01:31 AM

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
03/30/2021 and conducted by Evaluator Michael Smith

COMPLAINT CONTROL NUMBER: 27-AS-20210330143915

FACILITY NAME:	PONTE PALMERO		FACILITY NUMBER:	097004177
ADMINISTRATOR:	KASNER, GREGORY		FACILITY TYPE:	740
ADDRESS:	3083 PONTE MORINO DRIVE		TELEPHONE:	(530) 677-9100
CITY:	CAMERON PARK	STATE: CA	ZIP CODE:	95682
CAPACITY:	250	CENSUS: 175	DATE:	03/23/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Greg Kasner		TIME COMPLETED:	09:15 AM

ALLEGATION(S):

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Facility failed to seek timely medical attention

Staff are not meeting the needs of the resident

Insufficient staffing to meet the needs of residents

Facility not following residents care plan

INVESTIGATION FINDINGS:

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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 a mask and maintained distance during the visit. LPA Smith conducted an unannounced complaint visit and met with Greg Kasner.

Allegations:
Facility failed to seek timely medical attention
Resident in question has chronic continual edema, no other aggravating symptoms and a rash that did not arise to the level of an emergency visit according to the facility RN. RN is fully qualified to make that determination, specifically with the day to day knowledge of the resident's chronic condition. Based on this, the allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Michael Smith	TELEPHONE: (916) 208-7807
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022

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 27-AS-20210330143915

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: PONTE PALMERO	FACILITY NUMBER: 097004177
	VISIT DATE: 03/23/2022

NARRATIVE

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Staff are not meeting the needs of the resident
Copy of resident's care plan / schedule were obtained. Complainant alleges that resident was in the same clothes 1 week later. There is no evidence that 1) Resident remained in the same clothes for the week and 2) didn't wear any other clothes for the 6 other days in between observations. Based on this, the allegation is UNSUBSTANTIATED.

Insufficient staffing to meet the needs of residents
LPA received a copy of the staffing schedule for the month of March 2021. It appears that the facility was adequately staffed during the month of March. Additionally, a copy of the pendent response for the resident in question and the AL portion of the facility for March 2021, showed more than adequate response times, less than 15 minutes per occurrence, max. Based on this, the allegation is UNSUBSTANTIATED.

Facility not following residents care plan
Complainant is alleging not following care plan. According to charting notes, resident refused to take a shower on 3/31. According to Betsy, unless other wise noted, showers were given as scheduled. There is no proof / evidence that showers were not given during that time frame. Based on this, the allegation is UNSUBSTANTIATED.

As a result of this investigation, LPA finds the allegation that facility failed to seek timely medical attention, staff are not meeting the needs of the resident ,insufficient staffing to meet the needs of residents and facility not following residents care plan 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.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Michael Smith	TELEPHONE: (916) 208-7807
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022

LIC9099 (FAS) - (06/04)

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