317005900-10-26-2023-59-AS-APEZ-CX6LBH-20231101083645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 317005900
Report Date: 10/26/2023
Date Signed: 10/26/2023 03:55:10 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
07/17/2023 and conducted by Evaluator Sarena Keosavang

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230717124435

FACILITY NAME:	MEADOW OAKS OF ROSEVILLE		FACILITY NUMBER:	317005900
ADMINISTRATOR:	NATHAN CONDIE		FACILITY TYPE:	740
ADDRESS:	930 OAK RIDGE RD		TELEPHONE:	(916) 774-0200
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95661
CAPACITY:	108	CENSUS: 91	DATE:	10/26/2023
		UNANNOUNCED	TIME BEGAN:	01:57 PM
MET WITH:	Executive Director: Nathan Condie		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff who are not appropriately skilled professionals are administering medication to residents.

INVESTIGATION FINDINGS:

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On 10/26/2023, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to deliver investigation finding. LPA met with Executive Director (ED), Nathan Condie, and explained the purpose of the visit.

Throughout the course of the investigation, LPA conducted interviews with facility staff and reviewed pertinent documentation relevant to the allegation listed above such as resident's (R1) physician’s report, emergency contact, appraisals, assessments, doctor's orders, hospice communication logs, medication list, control substance management policy, staff roster, and residents roster.

Continue on page LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

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-20230717124435

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: MEADOW OAKS OF ROSEVILLE	FACILITY NUMBER: 317005900
	VISIT DATE: 10/26/2023

NARRATIVE

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According to complainant, this community uses unlicensed professional staff such as medication technicians (MT) to administer Morphine on hospice resident. According to R1’s physician’s report, R1 is unable to administer own prescription medications, unable to administer own PRN medications, and unable to store own medications. R1 is unable to administer own injections, perform glucose testing, and oxygen. According to R1’s level of care assessment, R1 requires medication assistance up to 2 times a day. R1 is on hospice and currently does not require additional staff involvement.

According to R1’s doctor’s orders, on 8/30/2022 Morphine 20 mg/mL liquid concentration (30 mL bottle) was prescribed to R1 per instruction administer 0.5 mL sublingually 2 times per day for pain or shortness of breath this is additional to PRN dose on 6/16/2023. On 8/4/2023, doctor’s orders indicated to discontinue Morphine 20 mg/mL oral concentration administer 0.5 mL 2 times per day. Begin Morphine 20 mg/mL oral concentration, administer 0.5 mL (10mg) sublingually 3 times per day for pain and shortness of breath, this is in addition to PRN dose. On 8/22/2023, Morphine is to be administered every 4 hours for pain and shortness of breath, this is in addition to PRN dose.

The Department interviewed and received statements from a total of five (5) Med Techs. Med Techs denies administering Morphine to hospice residents. Interview statement received from Med Techs indicated the facility nurse who is a Licensed Vocational Nurse (LVN), hospice nurse, and residents' family members who are trained administer Morphine to residents who are not capable to assist themselves. Med Techs indicated, if a resident in care is capable of administering own medication without assistance Med Tech is to provide medication to resident and observe to ensure the safety of resident.

On 9/18/2023, the Department received interview statement from R1's hospice nurse. Hospice nurse stated resident was prescribed Morphine and family members requested for R1 to be given additional doses for comfort. Hospice Nurse stated did not witness staff that are not skilled professional give morphine to R1. Hospice Nurse stated has worked at Meadow Oaks of Roseville for 6 years and has not witnessed unlicensed professional staff assisting R1 with Morphine. Hospice Nurse indicated Meadows Oaks of Roseville is good at contacting hospice to ensure that any medications such as narcotics are given to resident correctly with permission. Hospice Nurse indicated Meadow Oaks would always call hospice if they had any questions or concern or need recommendations/guidance.

The Department finds the allegations to be UNSUBSTANTIATED, meaning 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, and the findings are unsubstantiated.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC9099 (FAS) - (06/04)

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