125000579-2-9-2024-21-AS-CMAZ-D2F2KF-20240213162753

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 125000579
Report Date: 02/09/2024
Date Signed: 02/09/2024 09:10:13 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/18/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20230918144542

FACILITY NAME:	TIMBER RIDGE AT EUREKA		FACILITY NUMBER:	125000579
ADMINISTRATOR:	FARNUM, LARONA		FACILITY TYPE:	740
ADDRESS:	2740 TIMBER RIDGE LANE		TELEPHONE:	(707) 443-3000
CITY:	EUREKA	STATE: CA	ZIP CODE:	95503
CAPACITY:	75	CENSUS:	DATE:	02/09/2024
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Larona Farnum		TIME COMPLETED:	09:15 AM

ALLEGATION(S):

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Questionable death
Staff did not ensure resident's restricted health care need was performed by an appropriately skilled professional

INVESTIGATION FINDINGS:

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At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to deliver findings from an investigation conducted by the Department into the above allegations. LPA met with Executive Director Larona Farnum. Reporting party (RP) alleges resident’s (R1) catheter was placed by facility non-medical staff resulting in R1’s questionable death, death due to sepsis caused by misposition of the catheter placed by facility staff. Based on records reviewed and interviews conducted, Six out of six staff interviewed said they do not insert catheters or change resident catheter bags but are only trained to empty the bag and watch for infection or other warning signs. Based on a review of facility policies regarding catheter care, facility staff do not perform insertion of a catheter or change drainage bags. These items are only performed by a skilled medical professional. Continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

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 21-AS-20230918144542

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: TIMBER RIDGE AT EUREKA	FACILITY NUMBER: 125000579
	VISIT DATE: 02/09/2024

NARRATIVE

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The facility does not employ skilled medical professionals and requires all residents who need these services to receive it from home health providers or their physician. Home Health records were obtained and documented that a visit was conducted on 08/02/2022 and stated residents’ catheter was draining adequate amounts of clear yellow urine without sediment or odor and vitals were normal. On 08/06/2022, an additional visit was made to change the catheter. Vitals were normal during this period. The Registered Nurse who conducted the visit on 08/06/2022 was interviewed and stated the catheter was placed correctly, as evidenced by resident having clear urine return, but stated the catheter could have been inadvertently dislodged afterwards.

There was not enough evidence obtained to substantiate that facility staff inserted resident’s catheter incorrectly or at all. Therefore, the allegation of questionable death due to non-medical staff misplacement of catheter resulting in R1's sepsis is unsubstantiated.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

LIC9099 (FAS) - (06/04)

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