312700042-9-26-2024-59-AS-KHOS-D9LLT8-20240930090154

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700042
Report Date: 09/26/2024
Date Signed: 09/26/2024 12:05:10 PM

Unsubstantiated

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
01/11/2024 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20240111104820

FACILITY NAME:	SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	312700042
ADMINISTRATOR:	MARK MORRIS		FACILITY TYPE:	740
ADDRESS:	567 3RD STREET		TELEPHONE:	(916) 409-4150
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	132	CENSUS: 66	DATE:	09/26/2024
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Megan Gallagher		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Unqualified staff is providing care and supervision to diabetic residents
Unqualified staff is administering medication
Staff mishandled the residents medical records
Staff did not meet the residents medical needs while in care
Staff mishandled the residents medications
Staff did not properly discard expired medication
Staff are not being properly trained

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Thursday September 26, 2024 to complete and deliver findings to a complaint received on 1/11/2024. LPA met with Administrator Megan and explained the purpose of the visit.

Throughout the course of the investigation, LPA interviewed the Administrator and staff. LPA reviewed staffing schedules, staff files, and CSMDR. The result of the investigation is as follows:

Allegations: Unqualified staff is providing care and supervision to diabetic residents, Unqualified staff is administering medication, Staff mishandled the residents medical records
LPA reviewed text messages between S1 and various facility employees. These text messages reveal that there were shifts when a nurse was not scheduled. However, LPA previously cited the facility on 10/11/2023 regarding unqualified staff performing insulin administration. LPA did not obtain or review any new information that the facility continued this practice after the citation was issued. According to current staff interviews, there is always a nurse in the building to perform the assigned tasks of a skilled

Unsubstantiated

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: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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 59-AS-20240111104820

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: SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 312700042
	VISIT DATE: 09/26/2024

NARRATIVE

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professional. No interviews revealed that an employee, who is not a nurse, is currently performing insulin administration.

Allegation: Staff are not being properly trained
LPA reviewed 8 staff files. These files were a mixture of care staff including nurse, med tech, and caregivers. LPA observed all the required documents in staff files. Additionally, LPA observed the required annual and continuous training for staff. No files revealed that staff were working independently prior to receiving the required training. Facility also provided in-service training which are conducted as needed.

Allegations: Staff did not meet the resident’s medical needs while in care, Staff mishandled the resident’s medications.
LPA interviewed staff who denied having any knowledge of a resident receiving a duplicate dose of medications. Staff stated that they follow doctor’s orders in regards to medications. LPA reviewed incident reports submitted to Licensing and did not identify any which discuss a resident’s medication being mismanaged.

Staff did not properly discard expired medication.
LPA interviewed staff who all described the proper process to destroy medications. Staff acknowledged that non-narcotics are destroyed with two employees. Narcotics are destroyed with the Administrator and one other employee. LPA reviewed centrally stored and destruction logs which were filled out appropriately.

Based on information obtained, LPA finds the allegations to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted. A copy of this report was provided to the facility.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

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