312700555-7-19-2021-27-AS-MSEY-C56RV5-20210722132057

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700555
Report Date: 07/19/2021
Date Signed: 07/19/2021 12:33:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/16/2021 and conducted by Evaluator Melana Llopis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20210216155122

FACILITY NAME:	SUMMERSET LINCOLN ASSISTED LIVING		FACILITY NUMBER:	312700555
ADMINISTRATOR:	BOYLE, SABRINA		FACILITY TYPE:	740
ADDRESS:	550 2ND ST		TELEPHONE:	(916) 644-3151
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	162	CENSUS: 64	DATE:	07/19/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Administrator, Sabrina Boyle		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Insufficient staffing to care for residents
Unqualified staff dispensing medication to residents
Medications not being reordered on time

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melana Llopis arrived at the facility on 07/19/2021 to deliver complaint findings for a complaint received on 02/16/2021. LPA met with Adminstrator, Sabrina Boyle and explained the purpose of the visit. Prior to the visit LPA completed the required daily self-screening questionnaire for symptoms of Covid-19 infection to affirm no COVID-19 related symptoms; contacted facility and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and wore the following Personal Protective Equipment (PPE): N-95 masks. Additionally, LPA was screened by staff, Trish Pugh upon entering the facility.

Throughout the course of the investigaiton, LPA conducted multiple interviews and reviewed documentation pertinent to the investigation.

Results are as follows:

***Continuation on LIC-9099C***

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

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 27-AS-20210216155122

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SUMMERSET LINCOLN ASSISTED LIVING	FACILITY NUMBER: 312700555
	VISIT DATE: 07/19/2021

NARRATIVE

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Allegation: Insufficient staffing to care for residents

Complaint alleged the facility did not have adequate staffing for R1. LPA reviewed R1’s records on 07/09/2021 and found R1 was placed on status checks every 30 minutes on 02/04/2021. R1 was placed on status checks due to an incident reported on 02/04/2021 where R1 was found after cutting herself using a tweezer. R1’s medical assessment (dated 12/06/2020) indicates R1 has known suicidal behavior. LPA spoke with Administrator who stated R1 had suicidal attempts involving medication prior to being admitted. The facility put R1 on medication management meaning R1 was unable to access medications. After the event on 02/04/2021, R1 was put on status checks and all sharp objects were removed from R1’s room. Administrator stated, since 02/04/2021, there have not been additional suicidal behavior. Incident report for R1 shows R1 was sent to the hospital the day of incident and seen by a behavioral nurse; R1 agreed to tell the facility or call 911 if they feel like harming themself. Administrator also stated R1’s husband resides at the facility but was dying at the time and that may have increased R1’s depression. LPA reviewed R1’s ADL charts for February 2021. ADL chart reviewed indicates the staff checked on R1 throughout the day and met resident’s daily needs and services. Additionally, LPA spoke with three (3) of three (3) residents in care; this included R1. Residents stated the facility staff check on them regularly and if they need any assistance they can press their pendant and the facility staff are there to help them. LPA finds allegation to be UNFOUNDED.

Allegation(s): Unqualified staff dispensing medication to residents, medications not being reordered on time.

Complaint alleged S1 is dispensing medication to residents and is not qualified to do so, medications are not being reordered on time for residents in care. LPA reviewed S1’s training and found S1 has been trained and certified to dispense medication to residents in care and training to be current.

LPA interviewed three (3) of three (3) staff. Staff stated they received sufficient training for their positions. Caregiver staff interviewed stated they do not dispense or handle medications.
LPA interviewed three (3) of thee (3) residents in care who stated the facility provides them their medications and they have not had any trouble with receiving their medications. LPA finds the allegation(s) to be UNFOUNDED.
Based on the information above, LPA finds the allegation to be UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.
No deficiencies are being cite.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

LIC9099 (FAS) - (06/04)

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