312700022-11-8-2022-25-AS-LMUZ-CL82SG-20221115163906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700022
Report Date: 11/08/2022
Date Signed: 11/08/2022 02:19:57 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
08/05/2022 and conducted by Evaluator DeAnna Williams-Lyons

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220805160406

FACILITY NAME:	GRACE GARDEN HOME CARE		FACILITY NUMBER:	312700022
ADMINISTRATOR:	BOT, MARY		FACILITY TYPE:	740
ADDRESS:	6410 WISP COURT		TELEPHONE:	(916) 781-9177
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95765
CAPACITY:	6	CENSUS: 5	DATE:	11/08/2022
		UNANNOUNCED	TIME BEGAN:	08:56 AM
MET WITH:	Mary Bot, Licensee		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Staff did not provide adequate wound care causing resident's wound to worsen
Facility doors are not secured or equipped with an auditory device or other alert feature to monitor exits

INVESTIGATION FINDINGS:

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On November 8 2022, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to deliver findings for the allegations above. LPA met with Mary Bot, Administrator and informed her the reason for the visit.
Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and a N-95 mask was worn for Personal Protective Equipment.
Staff did not provide adequate wound care causing resident's wound to worse
The Hospice Nurse (HN) confirmed that she is a Registered Nurse (RN) Case Manager and was interviewed. HN stated R1 wounds never progressed past stage 2 wounds and are now healing. Hospice records were obtained and document wound care for stage 1 and stage 2 wounds. The resident’s wounds never progressed past stage 2 and the resident is on hospice care.

Based on the information obtained, the allegation that staff did not provide adequate wound care causing resident's wound to worse is UNFOUNDED, meaning the allegation was false, could not have happened and/or is without a reasonable basis.

To continue see 9099-C...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

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 4

Control Number 25-AS-20220805160406

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: GRACE GARDEN HOME CARE	FACILITY NUMBER: 312700022
	VISIT DATE: 11/08/2022

NARRATIVE

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Insufficient staffing to meet resident needs
This investigation included interviews with 5 residents, 3 facility licensee, facility administrator and direct care staff. LPA reviewed service hours and compared the level of care for residents. The facility does have a contract with a caregiver agency that will send over caregivers upon request to ensure the staffing level is met.

Based on the information obtained, the allegation that there is Insufficient staffing to meet resident needs is deemed UNFOUNDED at this time, meaning, that the allegation was false, could not have happened and/or is without a reasonable basis.

Facility doors are not secured or equipped with an auditory device or other alert feature to monitor exits
LPA arrived at the facility unannounced to conclude the complaint visit for the above allegations. LPA met with Administrator Mary Bot. Over the course of the investigation, LPA reviewed facility documents, conducted interviews, obtained copies of facility documents, and inspected facility grounds. The facility is equipped with an Auditory System on the doors which are used to notify staff. This signal system in the facility does meet guidelines for Title 22.

This agency has investigated the complaint alleging residents not given alarm devices. Based on LPA’s observation and records reviewed, 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.

To continue see 9099-C2

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 25-AS-20220805160406

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: GRACE GARDEN HOME CARE	FACILITY NUMBER: 312700022
	VISIT DATE: 11/08/2022

NARRATIVE

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C-2
Staff do not ensure that residents are fed nutritious meals with a sufficient quantity
It was alleged that facility staff failed to provide residents with nutritious meals. Staff and residents interviewed stated the food they receive was nutritious. LPA reviewed records, conducted interviews, and toured the facility in regard to the allegation. It was stated in interviews with 5 residents and 3 staff that fruits and vegetables are provided to residents "every day". LPA toured the facility and observed a large number of fruits and vegetables as well as eggs and dairy, and a large amount of fresh and frozen meat. LPA obtained the facility menu and observed that meals regularly include fruits and vegetables and appear to be nutritious and of the quality and in the quantity necessary to meet the needs of the residents. Based on information obtained, the allegation may have happened or is valid, however, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Administrator's designated substitute is not available to manage the facility in the Administrators absence. LPA interviewed staff members and reviewed documentation. Regarding the allegation that residents are not being properly supervised, and the substitute administrator is not available to manage the facility in the administrator’s absence all staff and residents interviewed expressed that they believe there is sufficient staff coverage. There are plans in place when staff call in sick to call extra staff or use a staffing agency if needed to stay fully staffed. Residents who require constant supervision are kept busy with in activities room in common areas. ADM2 stated never received any calls after hours or during hours when ADM2 was working. Regarding facility administrator, it was found that ADM2 has a current Administrator Certificate and has been acting as the main administrator until the parents (Licensees/Administrators) return from vacation.

Based on LPA’s observation and records reviewed, the allegation is UNSUBSTANTIATED, meaning although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
08/05/2022 and conducted by Evaluator DeAnna Williams-Lyons

COMPLAINT CONTROL NUMBER: 25-AS-20220805160406

FACILITY NAME:	GRACE GARDEN HOME CARE		FACILITY NUMBER:	312700022
ADMINISTRATOR:	BOT, MARY		FACILITY TYPE:	740
ADDRESS:	6410 WISP COURT		TELEPHONE:	(916) 781-9177
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95765
CAPACITY:	6	CENSUS: 5	DATE:	11/08/2022
		UNANNOUNCED	TIME BEGAN:	08:56 AM
MET WITH:	Mary Bot, Licensee		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Administrator's designated substitute is not available to manage the facility in the Administrators absenceStaff do not ensure that residents are fed nutritious meals with a sufficient quantity

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 4