312700033-9-19-2023-59-AS-MSEY-CVUT52-20230920142445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700033
Report Date: 09/19/2023
Date Signed: 09/19/2023 11:46:53 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/01/2023 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230901112315

FACILITY NAME:	GRANITE BAY COUNTRYHOUSE LLC		FACILITY NUMBER:	312700033
ADMINISTRATOR:	JESSICA SANDERS		FACILITY TYPE:	740
ADDRESS:	8485 BARTON RD		TELEPHONE:	(916) 899-6565
CITY:	GRANITE BAY	STATE: CA	ZIP CODE:	95746
CAPACITY:	49	CENSUS:	DATE:	09/19/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jessica Sanders		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident(s) sustained falls resulting in injury due to lack of care and supervision.
Facility staff did not follow physician orders.
Staff handle resident(s) in a rough manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

LPA Parks arrived on Tuesday September 19, 2023, to conclude a complaint investigation regarding the above allegations.

LPA met with Administrator Jessica and explained the purpose of the visit. Throughout the course of the investigation, LPA interviewed the Administrator, Wellness Director, Med techs, and caregivers. LPA reviewed R1’s file including physicians report, medication list, observation notes, and various other documents. The result of the investigation is as follows:

LPA was at the facility the day R1 had two falls. LPA observed R1’s falls occur in the common area of the facility. Both times, there were staff in the common area who responded immediately to the fall. Additionally, staff interviews acknowledged that resident was being supervised at the time the falls occurred.
LPA reviewed text messages between the Wellness Director and hospice nurse regarding a bed rail. Per new regulations, R1’s POA needed to sign authorization for a half rail for R1’s hospital bed. Bed rails are

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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 2

Control Number 59-AS-20230901112315

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GRANITE BAY COUNTRYHOUSE LLC	FACILITY NUMBER: 312700033
	VISIT DATE: 09/19/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

only ordered once requested by the POA and not automatically given to the resident as a part of their durable medical equipment. R1’s POA signed for bed rails on 9/1/2023. Bed rails were delivered later that day. Per the signed bed rail consent, “bedrails are considered a restraint and bring with them the risk of injury and death . . . Hospice encourages families/caregivers to consider alternative options in place of bedrails to help ensure the safety of patients.”

LPA reviewed R1’s medication list. There were no antibiotics ordered for R1. Per interviews with staff, R1’s POA declined an antibiotic when R1 was in the hospital. Therefore, the facility did not receive this order. Additionally, interviews with staff acknowledged that at R1’s end of stay at the facility, they needed encouragement to eat with meals. Staff stated that R1 was offered 3 meals per day, including liquids. Per interviews, R1 had the right to refuse, but they were still offering meals and assistance with feeding.

LPA interviewed staff who stated that there were never any witnessed accounts or reports of staff being rough with R1. Although R1 had a history of behaviors, staff stated that R1 was usually able to be redirected. Interviews with management stated that there were no reports to them about rough staff.

Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegations are found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. A copy of this report was left at the facility.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2