312700791-10-4-2023-59-AS-KHOS-CWGNB5-20231010101835

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700791
Report Date: 10/04/2023
Date Signed: 10/04/2023 02:09:17 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2023 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 59-AS-20230828102402

FACILITY NAME:	FOOTHILLS SENIOR CARE		FACILITY NUMBER:	312700791
ADMINISTRATOR:	MANGHIUC, MARIA		FACILITY TYPE:	740
ADDRESS:	425 KNOWLTON CT		TELEPHONE:	(916) 276-2687
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	6	CENSUS: 5	DATE:	10/04/2023
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Maria Manghiuc, Administrator		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Facility staff are providing treatments without physician orders

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings. LPA met with Maria Manghiuc during today’s facility inspection.
LPA investigated allegation, “Facility staff are providing treatments without physician orders.” LPA interviewed resident, staff, healthcare providers, and reviewed documentation. LPA interviewed relevant party in which they stated Administrator was not following physician orders for R1’s wound care. Relevant party stated that Administrator was using Medihoney instead of Betadine which was ordered by the physician. LPA interviewed physician in which they stated that she has received multiple phone calls from Administrator suggesting certain orders.

Continuation on 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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 59-AS-20230828102402

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: FOOTHILLS SENIOR CARE	FACILITY NUMBER: 312700791
	VISIT DATE: 10/04/2023

NARRATIVE

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The physician stated during the last visit with R1, R1 had the proper wound care in place. The physician stated they had heard the administrator was using Medihoney prior to order being given 8/31/23 but they had not seen it first hand. LPA interviewed administrator (registered nurse) in which she stated she has always followed physician orders and never used medihoney until ordered on 8/31/23. LPA interviewed resident in which they stated they could not remember when medihoney was used. Due to the conflicting information LPA finds the information to be UNSUBSTANTIATED.

Exit interview conducted.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC9099 (FAS) - (06/04)

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