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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005671
Report Date: 09/06/2023
Date Signed: 09/06/2023 04:26:28 PM

Substantiated


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
08/30/2023 and conducted by Evaluator Todd Tryon
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20230830082900
FACILITY NAME:ALMOND GARDENSFACILITY NUMBER:
317005671
ADMINISTRATOR:NISHA PATELFACILITY TYPE:
740
ADDRESS:174 ALMOND STREETTELEPHONE:
(530) 885-5678
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:10CENSUS: 7DATE:
09/06/2023
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Jennifer Clarke, AdministratorTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff transfers medications between containers,
INVESTIGATION FINDINGS:
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On September 6, 2023 LPA Tryon visited the facility to open the complaint. LPA met with Administrator Jennifer Clarke.
LPA toured the facility, spoke with staff, spoke with residents, reviewed medications in the Med Room, reviewed Activity Schedule, viewed food in refrigerator/freezer, cupboards and pantry.
Regarding the allegation that Staff transfers medications between containers, in speaking with the Administrator and staff, LPA learned that medications are "pre-poured" by the NOC (night) shift for the rest of the following day, for each medication time. LPA viewed the medications and saw that they had been poured into labeled "condiment" cups set inside plastic trays which had covers and were labeled. The system appears very organized, well-thougt out and clear. However, this practice does not meet the regulation that "each resident's medication shall be stored in its original container. No medications shall be transferred between containers. Therefore, the allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiency is cited as per Title 22 Regulations. Appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
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 4
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
08/30/2023 and conducted by Evaluator Todd Tryon
COMPLAINT CONTROL NUMBER: 59-AS-20230830082900

FACILITY NAME:ALMOND GARDENSFACILITY NUMBER:
317005671
ADMINISTRATOR:NISHA PATELFACILITY TYPE:
740
ADDRESS:174 ALMOND STREETTELEPHONE:
(530) 885-5678
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:10CENSUS: 7DATE:
09/06/2023
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Jennifer Clarke, AdministratorTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff do not protect food against contamination.
Staff did not ensure that residents' incontinence needs are met.
Staff do not make planned activities available to residents
INVESTIGATION FINDINGS:
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 Regarding the allegation that staff do not protect food against contamination, LPA toured the kitchen and pantry, spoke with staff and residents. LPA found food in the refrigerators and pantry to be labeed with dates opened. Dates were done in "Sharpie" pen. LPA found no evidence that dates had been changed or altered; and it would be very difficult to try to "erase" dates marked in Sharpie marker without leaving any trace or shadow of old dates; LPA did not find any of this. Staff explained food is marked after it is opened; that fresh foods are only kept for about 3 days then disposed. New food supplies are purchased once a week from a weekly menu, and food is purchased specifically for that menu. Residents interviewed confirmed that food is fresh, they have never been served food that seemed spoiled or old. Food stored appeared in good condition and fresh. LPA finds the allegation to be UNFOUNDED.
Regarding the allegation that staff did not ensure that residents' incontinence needs are met, LPA interviewed staff and residents. LPA was informed that people who need assistance with changes/incontinence are checked at least every 2 hours, more often if necessary. Staff are familiar with each person's needs and habits. There are only a few people in the home who need regular assistance. Hospice
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 59-AS-20230830082900
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: ALMOND GARDENS
FACILITY NUMBER: 317005671
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/07/2023
Section Cited
CCR
87465(h)(5)
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The following requirements shall apply to medications which are centrally stored: Each residents medication shall be stored in its originally received container. No medications shall be transferred between containers This regulation is not met as evidenced by:
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The facility will submit a plan of how medication administration will be accomplished without pre-pouring/transferring client medications into other containers ahead of time; and that the medications are readied and given to residents by the same staff person (not poured by one and handed
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Through interview of staff and review of medications, LPA found that medications are "pre-poured" by the NOC (night) shift for the rest of the following day, for each medication time, into labeled paper condiment cups, which are stored in a plastic covered tray that is labeled with rooms/names/times.
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to the resident by a different staff.)
Plan to be submitted to CCL by 9/7/2023.
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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: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 59-AS-20230830082900
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: ALMOND GARDENS
FACILITY NUMBER: 317005671
VISIT DATE: 09/06/2023
NARRATIVE
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SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4