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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005413
Report Date: 11/30/2022
Date Signed: 11/30/2022 04:42:55 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
05/09/2022 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 25-AS-20220509140752
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
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Yas Patawaran, AdministratorTIME COMPLETED:
04:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not address resident's pressure sore causing it to advance to a stage 3 pressure injury

Staff did not inform responsible party of resident's change in condition
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Yas Patawaran, to deliver findings into the allegations listed above. LPA wore a surgical mask. Facility staff wore masks while on the premises.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

Allegation: Facility did not address resident's pressure sore causing it to advance to a stage 3 pressure injury

** Report continued on 9099-C **
Substantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 25-AS-20220509140752
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
Resident (R1’s) pre-placement documents indicate that R1 had “at least” a stage 2 pressure injury when R1 was admitted to the facility in January of 2022. Administrator, Yaser “Yas” Patawaran, reported that R1’s pressure injury was not reassessed to determine if it was accurately diagnosed as a stage 2 wound. Administrator explained that the plan of care for R1’s wound included using contracted nurses (coordinated by Care Home by RNs) to provide wound care two to three times a week; have caregivers reposition R1 every two hours; and utilize a pressure relieving mattress. A written wound care plan was not provided to the Department. Interview with Nurse Practitioner (NP) from Care Home by RNs indicated that, since R1’s wound was stage 2, it did not require the nurses to be involved with wound care. Interview with Nurse from Care Home by RNs denied providing wound care to R1. Administrator and NP reported that the pressure injury worsened overtime. NP stated that they were notified of the pressure injury worsening, but before they or another nurse was able to assess the wound, R1 was hospitalized for an unrelated reason (04/25/2022). Caregiver interviews reported different interventions regarding R1’s wound, which included the following: repositioning R1 every two hours; changing R1’s diaper to keep them dry; changing the dressing on the wound; and applying a cream (unknown name) to the pressure injury. There was no documentation available to support that caregivers completed these tasks. During interviews, caregivers denied that the pressure injury had gotten worse.

Interview with Administrator indicated that R1’s health care company, Innovage, was notified of the pressure injury worsening. Innovage records do not show that Innovage was notified of the pressure injury worsening overtime. Innovage was notified on 02/07/2022 that R1 had redness of sacrum with blanches and no skin breakdown. Innovage records do not show that they assessed the wound or provided wound care.

R1 was seen by Snowline Supportive Care and Valley Rehab since December of 2021 and they did not provide wound care for R1. Nurses from Care Home by RNs also did not provide wound care for R1. Hospital records from 04/25/2022 show that R1 had a stage 3 pressure injury. R1 did not receive any medical care for the pressure injury prior to their hospitalization.

Interview with R1 indicated that they did not recall living at the facility. File review documents show that R1 is in bed most of the time and they require assistance with transferring in and out of bed, bathing, dressing, and moving about the facility.
** Report continued on 9099-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
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 25-AS-20220509140752
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
Allegation: Interview with relevant party indicated that they were not informed regarding resident’s change in condition.

During visit conducted on 11/15/2022, LPA requested copies of incident reports for 2022. LPA observed that the facility did not have an incident report for R1 being transferred to the hospital on 4/25/2022. Interviews with staff members S1 and S2 indicated that, whenever a resident is transferred to the hospital, the Administrator and the resident’s family are notified regarding the transfer by the caregiver. S1 and S2 stated that contacts made regarding resident’s transfer to the hospital are not documented by the caregiver.

Interview with Administrator conducted on 11/30/2022 indicated that an incident report was not documented for R1's transfer to the hospital on 4/25/2022.

Based on interviews conducted and records reviewed by the Department, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. As a result of the resident’s serious bodily injury, an immediate civil penalty per Health and Safety Code § 1548 in the amount of $500 for the date of 11/30/2022 is assessed for a violation that the department determines resulted in the injury or illness of a person in care. An additional civil penalty assessment is under review and a determination is pending. LPA will return on a future date to assess an additional civil penalty if warranted.

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
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 25-AS-20220509140752
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
CCR
87466
1
2
3
4
5
6
7
87466 Observation of Resident - The licensee shall ensure that residents are regularly observed for changes in physical (...) functioning and that appropriate assistance is provided when such observation reveals unmet needs. (...) This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Facility will conduct in-service training for staff regarding observation of residents and response time. Licensee will submit to LPA information regarding in-service training, including time and date of in-service and training material, by POC due date of 12/01/22.
8
9
10
11
12
13
14
Based on interviews conducted and records reviewed, the facility did not ensure resident R1 received care and supervision for a stage 2 pressure injury, resulting in the development of a stage 3 pressure injury, which posed an immediate health, safety, and personal rights risk to the residents in care.
8
9
10
11
12
13
14
An immediate civil penalty of $500 was assessed today per Health and Safety Code § 1548 due to a violation that the department determines resulted in the injury or illness of a person in care.
Type B
12/15/2022
Section Cited
CCR
87211(a)(1)(B)
1
2
3
4
5
6
7
87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of (...) (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Administrator will complete a statement of understanding regarding regulation 87211. Administrator will submit statement of understanding to LPA by POC due date of 12/15/22.
8
9
10
11
12
13
14
Based on interviews conducted and records reviewed, the facility did not ensure R1's responsible party and CCLD were notified regarding R1 being transferred to the hospital due to a change in condition (stage 3 pressure injury) on 4/25/2022 , which posed a potential health, safety, and personal rights risk to the residents in care.
8
9
10
11
12
13
14
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
LIC9099 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
05/09/2022 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 25-AS-20220509140752

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
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Yas Patawaran, AdministratorTIME COMPLETED:
04:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not assist resident with incontinence care

Facility smells malodorous
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Yas Patawaran, to deliver findings into the allegations listed above. LPA wore a surgical mask. Facility staff wore masks while on the premises.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

Allegation: Staff did not assist resident with incontinence care

** Report continued on 9099-C **
Unsubstantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 25-AS-20220509140752
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
Interviews with resident R2 and staff members S1 and S2 indicated that residents receive incontinence care in accordance with their needs and services plan. Interviews with residents R3, R4, and R5 indicated that they do not have any concerns regarding the facility. All other interviews conducted by the Department did not indicate any concerns regarding residents receiving incontinence care.

Facility smells malodorous

Interviews with R2, S1, and S2 indicated that the facility does not smell unpleasant. Interviews with residents R3, R4, and R5 indicated that they do not have any concerns regarding the facility. All other interviews conducted by the Department did not indicate any concerns regarding smells at the facility. During visits conducted on 5/10/2022, 11/15/2022, and 11/30/2022, LPA did not observe any malodorous smells at the facility.

Based on interviews conducted and observation, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation 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 was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator 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
LIC9099 (FAS) - (06/04)
Page: 6 of 6