167200404-5-20-2024-24-AS-BCHN-D5GP4X-20240521105951

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 167200404
Report Date: 05/08/2024
Date Signed: 05/20/2024 09:27:35 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/29/2024 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 24-AS-20240429084845

FACILITY NAME:	DIAMOND TERRACES		FACILITY NUMBER:	167200404
ADMINISTRATOR:	NORMAN, ROBERT		FACILITY TYPE:	740
ADDRESS:	600 E. 11TH STREET		TELEPHONE:	(559) 585-8010
CITY:	HANFORD	STATE: CA	ZIP CODE:	93230
CAPACITY:	38	CENSUS: 21	DATE:	05/08/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Licensee, Jan Norman		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff neglect resulted in resident sustaining a fall injury
Facility did not report injury to resident’s authorized representative

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on the allegations listed above. LPA met with Facility Licensee Jan Norman, and explained the purpose of today's visit.

Regarding the allegation Staff neglect resulted in resident sustaining a fall injury. Resident 1 needs assistance with transfer to and from their wheelchair. Facility staff has been advised to have hands on Resident 1 at all times during any transfers. Staff 1 stated Resident 1 did sustain two separate falls at the facility on March 10, 2024, and April 25, 2024. Staff 1 stated both falls occured when facility staff removed their hands from Resident 1 for a brief moment during transfer from wheelchair. Resident 1's fall on April 25, 2024 resulted in substantial bruising to the face, and head area. Based on LPA's interview conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Continued...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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 3

Control Number 24-AS-20240429084845

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: DIAMOND TERRACES	FACILITY NUMBER: 167200404
	VISIT DATE: 05/08/2024

NARRATIVE

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...Continued

Regarding the allegation Facility did not report injury to resident’s authorized representative. Staff 1 stated they did not report Resident 1's fall to State Licensing, or their Responsible Party. Based on LPA interview conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

The following deficiencies are being cited Per Title 22 Regulations.

Exit interview conducted with facility Licensee Jan Norman and a copy of this report along with appeals rights provided.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 24-AS-20240429084845

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: DIAMOND TERRACES	FACILITY NUMBER: 167200404
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/09/2024 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements - General(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. The following requirement has ot been met as evidenced by:	1 2 3 4 5 6 7	Licensee will conduct "transfer" training with facility care staff, and send proof to LPA by POC date of 05/09/2024.
	8 9 10 11 12 13 14	Resident 1 sustained two separate falls in the facility due to staff not properly transferring, which poses an immediate, health, safety, or personal rights risk to residents in care.	8 9 10 11 12 13 14
Type B 05/22/2024 Section Cited CCR 87211(a)	1 2 3 4 5 6 7	87211 Reporting Requirement (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: The following requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Licensee will conduct training with facility staff on Reporting Requirements, which poses a potential, health, safety, risk to residents in care.
	8 9 10 11 12 13 14	State Licensing, and Resident 1's Responsible Party was not notified of Resident 1's fall resulting in injury, facility did not follow instructions on licensing form LIC624, which poses a potential, health, safety, or personal rights risk to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC9099 (FAS) - (06/04)

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