312700042-10-26-2022-25-AS-MSEY-CKLKE5-20221027074944

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700042
Report Date: 10/25/2022
Date Signed: 10/26/2022 04:02:24 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
03/22/2022 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220322162547

FACILITY NAME:	SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	312700042
ADMINISTRATOR:	JO ANN FRANKLIN		FACILITY TYPE:	740
ADDRESS:	567 3RD STREET		TELEPHONE:	(916) 409-4150
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	132	CENSUS: 73	DATE:	10/25/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Mark Morris		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Neglect/ lack of care and supervision resulted in resident sustaining fractures
Staff neglect resident while in care
Staff failed to provide a comfortable temperature for resident in care
Staff failed to respond to resident’s call assistance button in a timely manner
Resident sustained multiple UTIs while in care
Facility has insufficient staffing to meet residents’ needs
Staff failed to make sure resident was hydrated
Staff mismanaged resident’s medication
Staff overcharged resident and Staff failed to keep resident's room clean

INVESTIGATION FINDINGS:

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LPA Parks arrived on Tuesday October 25, 2022 to conclude a complaint investigation regarding the following allegations: neglect/lack of care and supervision resulted in resident sustaining fractures, staff neglect to resident while in care, staff failed to provide a comfortable temperature for resident in care, staff failed to respond to resident's call assistance button in a timely manner, resident sustained multiple UTIs while in care, facility has insufficient staffing to meet residents' needs, staff failed to make sure resident was hydrated, staff mismanaged resident's medication, staff overcharged resident, and staff failed to keep resident's room clean.

Prior to the visit, LPA completed the required COVID-19 testing protocols and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

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: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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 25-AS-20220322162547

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: SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 312700042
	VISIT DATE: 10/25/2022

NARRATIVE

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Throughout the course of the investigation, LPA reviewed the following documentation: R1's physicians report, medication administration record (MAR), hospital discharge paperwork, care notes, medication list, and admission agreement. Additionally, LPA reviewed a restraining order in place for R1. LPA interviewed the following relevant parties: facility staff including management, activities director, housekeeping, caregivers, and med techs. Based on the review of documentation and interviews conducted, LPA concluded the following: the facility staffing is sufficient to meet the resident's needs. If there are staff who call in sick, management will find a replacement. Therefore, R1 has not experienced neglect due to staffing issues. Additionally, while R1 has a history of falls and UTIs, this was not due to facility staffing. All staff interviewed acknowledge that R1's room is kept neat and orderly. R1's thermostat is kept at a reasonable temperature. Additionally, R1 can vocalize to staff if she wishes her thermostat to be adjusted. All staff acknowledge that R1 spends the majority of her day in the common area, amongst activities staff and caregivers. Staff perform frequent checks on her throughout the day and night. LPA was unable to find any medication errors with R1's MAR. Per documentation reviewed, facility is following doctors orders in regards to medication. LPA learned that the facility is offering fluids to R1 appropriately. R1 is offered a variety of liquid throughout the day including coffee, water, and juice (3 meals plus 2 snack times each day). Additionally, R1 has a water bottle in her room to assist with hydration.

Based on LPAs interviews and review of documentation, 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: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC9099 (FAS) - (06/04)

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