312700555-8-1-2023-25-AS-MSEY-CUCTL7-20230803144904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700555
Report Date: 08/01/2023
Date Signed: 08/01/2023 02:35:34 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
01/20/2023 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20230120115007

FACILITY NAME:	SUMMERSET LINCOLN ASSISTED LIVING		FACILITY NUMBER:	312700555
ADMINISTRATOR:	MORRIS, SHALON		FACILITY TYPE:	740
ADDRESS:	550 2ND ST		TELEPHONE:	(916) 644-3151
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	162	CENSUS: 95	DATE:	08/01/2023
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Jeff Dolittle		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff do not respond to residents call buttons in timely manner
Facility staff are not properly supervising residents who may be a fall risk
Staff do not assist residents with transfers in a timely manner
facility left resident on floor for extended amount of time

INVESTIGATION FINDINGS:

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LPA Parks arrived on August 1, 2023, to conclude a complaint investigation regarding the above allegations. LPA met with Administrator Jeff and explained the purpose of the visit.

Throughout the course of the investigation, LPA interviewed the previous Administrator, current Administrator, facility staff, and current residents. LPA reviewed R1’s file including R1’s physicians report, care plan, and resident notes.

LPA learned that R1 has a history of agitation and restlessness. A review of their charting notes detail how R1 would often attempt to get out of bed. Staff would often find them 'half in, half out' of bed. R1 had a PRN which would be given to help alleviate their restlessness. Charting notes also detailed staff providing frequent checks, communication with other shifts, and hospice. No interviews acknowledged that R1 was on the floor for an extended period of time. R1’s care plan stated that staff are to provide status checks four times per shift. R1’s apartment was close to the nursing station, so staff would often check outside of the established status checks.

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: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

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-20230120115007

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	FACILITY NUMBER: 312700555
	VISIT DATE: 08/01/2023

NARRATIVE

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LPA was able to interview three residents who require two staff in order to help with transfers and activities of daily living. Residents interviewed stated that staff are timely in answering pendants. Staff interviewed stated that when a resident requires two staff assist, one staff will answer the pendant and call for another staff to assist. Sometimes this requires a wait period until a second staff is available.

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

Exit interview. A copy of this report was emailed to the Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

LIC9099 (FAS) - (06/04)

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