286803597-3-30-2021-21-AS-BMOS-BZPT7D-20210402142833

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 286803597
Report Date: 03/30/2021
Date Signed: 03/30/2021 02:13:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/12/2021 and conducted by Evaluator Marisol Cuadra

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20210112163343

FACILITY NAME:	NAZARETH CLASSIC CARE OF NAPA		FACILITY NUMBER:	286803597
ADMINISTRATOR:	SIOCO, CHIRISSA		FACILITY TYPE:	740
ADDRESS:	2465 REDWOOD ROAD		TELEPHONE:	(707) 258-8300
CITY:	NAPA	STATE: CA	ZIP CODE:	94558
CAPACITY:	46	CENSUS: 28	DATE:	03/30/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Erlinda Ferris (Administrator)		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff do not ensure that resident's needs are met
Staff do not ensure that resident has clean linens
Staff do not ensure that resident is properly clothed
Staff did not ensure that facility was kept at a comfortable temperature

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisol Cuadra conducted a complaint investigation regarding the above allegations. Tele-visit with Administrator, Erlinda Ferris was conducted due to COVID-19 precautions on March 30, 2021 and on this date for the purpose of closing the complaint.

During this investigation LPA made observation, conducted interviews and reviewed records. Reporting party had concerns about staff do not ensure that resident's needs are met. Complainant alleges resident (R1) was observed very wet during past three visits. Based on confidential interviews conducted with staff (S1, S2, S3, S4 &S5) on 2/11/21 and 2/23/21 indicated that staff are assisting residents with their needs at least every two hours as stipulated in facility plan of operation. LPA obtained daily shift endorsement forms, daily task/assignment sheets, daily service notes for R1 for three consecutive weeks confirmed that R1 was placed and assisted in shower schedule pertaining to Group #1 of residents; R1 was also assisted with incontinence needs daily every two hours as instructed in Needs and Services Plan dated 12/8/20, “resident will be placed in our 2-hour incontinent log and be assisted to remain clean, dry and odor free; Resident will be placed on our 2 day per week shower schedule”.
Continues on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2021

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-20210112163343

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: NAZARETH CLASSIC CARE OF NAPA	FACILITY NUMBER: 286803597
	VISIT DATE: 03/30/2021

NARRATIVE

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Continued from LIC9099...

A finding that the complaint allegation Staff do not ensure that resident’s needs are met is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation of staff do not ensure that resident has clean linens. Based on LPA observations during tele-visits conducted on 3/15/21 and 3/18/21 clean linens were observed at resident’s rooms and large linen closet which was full of linens including towels and bedding. Closet was locked during visit and based on staff interviews conducted on 2/11/21 all caregivers have access to the linen closet. LPA conducted interviews regarding linen changes based on observations and interviews LPA was unable to obtain additional information. A finding that the complaint allegation Staff do not ensure that resident has clean linens is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation of staff do not ensure that resident is properly clothed. Reporting party alleged that R1 mentioned that they were cold and was observed wearing a T-shirt. During tele-visit conducted on 3/18/21 with Office Coordinator, LPA observed that residents were dressed accordingly to the weather. Also, confidential interviews conducted on 3/18/21 with residents (R3, R4, R5 and R6) confirmed the same information. Although, LPA requested to the facility Client/Resident Personal Property (LIC 621 form) and was informed that “this is something we don’t normal complete since residents only come in with the basics such as: clothes, shoes and diapers”. However, during records reviewed of facility plan of operation it states that LIC621 form is to be “used to document resident’s personal property inventory. This inventory will be updated as often as necessary”. LPA will address to follow plan of operation on a case management inspection. A finding that the complaint allegation Staff do not ensure that resident is properly clothed is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED

Regarding allegation staff did not ensure that facility was kept at a comfortable temperature. Based on LPA observations during tele-visits conducted on 3/15/21 and 3/18/21 LPA observed thermostat was set at 70 degrees F and 74 degrees F respectively which is within regulation. Also, thermostat was observed with a sign that states: “Don’t lower temperature below 70” and locked. Residents and staff interviews conducted on 2/11/21 and 3/18/21 concluded the facility is at a comfortable temperature. A finding that the complaint allegation Staff did not ensure that facility was kept at a comfortable temperature is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited during today’s inspection.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/12/2021 and conducted by Evaluator Marisol Cuadra

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20210112163343

FACILITY NAME:	NAZARETH CLASSIC CARE OF NAPA		FACILITY NUMBER:	286803597
ADMINISTRATOR:	SIOCO, CHIRISSA		FACILITY TYPE:	740
ADDRESS:	2465 REDWOOD ROAD		TELEPHONE:	(707) 258-8300
CITY:	NAPA	STATE: CA	ZIP CODE:	94558
CAPACITY:	46	CENSUS: 28	DATE:	03/30/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Erlinda Ferris (Administrator)		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff do not allow resident to have visitors

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisol Cuadra conducted a complaint investigation regarding the above allegations. Tele-visit with Administrator, Erlinda Ferris was conducted due to COVID-19 precautions on March 30, 2021 and on this date for the purpose of closing the complaint.
Regarding the allegation of staff do not allow resident to have visitors. On 10/6/20 Community Care Licensing issued PIN 20-38- ASC to all adult and senior care program residential licensees and provided updated guidance on testing, infection control protocols, communal gatherings and statewide waiver related to visitation. PIN 20-38-ASC advises the licensee of each facility that they must allow essential visits, virtual visits and scheduled outdoor visit at all times. Reporting party alleged that two persons tried to visit R1 and were turned down. On 1/13/21 LPA conducted confidential interviews with outside party who stated that they were offered a window visit only. This allegation was issued on 1/12/21 in the middle of Covid19 per CCL guidelines there was no visitors allowed at the facility at that time. On 1/20/21 facility provided “Provider sign-in-out log” for the month of November and December 2020 which included the purpose of the visit and all of them were essential visitors. This agency has investigated the complaint alleging staff do not allow resident to have visitors. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies cited during today's inspection.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2021

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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