<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005413
Report Date: 11/30/2022
Date Signed: 11/30/2022 05:20:47 PM


Document Has Been Signed on 11/30/2022 05:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ASPEN MEADOWSFACILITY NUMBER:
317005413
ADMINISTRATOR:WILSON, ALBERTFACILITY TYPE:
740
ADDRESS:531 ASPEN MEADOWS WAYTELEPHONE:
(916) 409-5620
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:6CENSUS: 3DATE:
11/30/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:40 PM
MET WITH:Yas Patawaran, AdministratorTIME COMPLETED:
05:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Michael Hood met with Administrator, Yas Patawaran, to conduct a case management visit. During an investigation conducted by the Department, the following information was discovered:

Interview with Administrator conducted by the Department on 6/22/2022 and review of resident (R1’s) supportive care records indicated that R1 was bedbound and not receiving hospice services. Interviews with staff members S1 and S3 conducted by the Department on 6/22/2022 indicated that R1 has been bedbound since they were admitted to the facility. Interviews also indicated that R1 was receiving assistance with rotation in bed every 2 hours. Interviews with residents R3 and R5 conducted by the Department on 6/22/2022 indicated that both residents are in bed most if not all day and receive assistance with repositioning in bed by staff.

LPA conducted a records review of resident files for residents R1, R3, R4, and R5. LPA observed that R3 was admitted to hospice services on 9/28/2022 (prior to interview conducted by the Department on 6/22/2022). Observations of both LIC 602s for R1 (dated 1/26/2022) and R3 (dated 7/8/2021) indicated that both non-ambulatory and bedridden were marked, with bedridden crossed out and no initials from a physician. R1’s file did not indicate that R1 was receiving hospice services.

LIC 602 defines bedridden as “a person who requires assistance with turning or repositioning in bed.” Interviews with staff members S1 and S2 indicated that residents R3, R4, and R5 were bedbound, in bed most if not all day 7 days a week, and received assistance with turning and repositioning in bed. According to records reviewed of resident files, only R3 and R5 were admitted to hospice (R3 on 9/28/2022 and R5 on 9/7/2022). R5 was admitted to the facility on 3/1/2022 and has a pre-placement appraisal stating that R5 is “mostly bedbound.”
** Report continued on 809-C **
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: ASPEN MEADOWS
FACILITY NUMBER: 317005413
VISIT DATE: 11/30/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on CCLD records and facility sketch, the facility does not have a fire clearance that approves the facility to admit and retain residents who are considered bedridden.

Due to interviews conducted and records reviewed, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Section 87455(b)(6) regarding acceptance and retention limitations . Deficiency is listed on 809-D.

Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. The Administrator’s signature on these forms acknowledges receipt of these documents.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/30/2022 05:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926


FACILITY NAME: ASPEN MEADOWS
FACILITY NUMBER: 317005413

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/01/2022
Section Cited

1
2
3
4
5
6
7
87455 Acceptance and Retention Limitations (b) The following persons may be accepted or retained in the facility: (6) Persons who are bedridden provided the requirements of Section 87606 are met. This requirement is not met as evidenced by:
8
9
10
11
12
13
14
Based on interviews conducted and records reviewed, the facility did not ensure the proper procedures for accepting and retaining residents who are considered bedridden were conducted, which poses an immediate health, safety, and personal rights risk to the residents in care.
8
9
10
11
12
13
14
Administrator will submit statement of understanding and reassessment of R4 to LPA by POC due date of 12/01/22.

1
2
3
4
5
6
7

1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3