342700067-2-21-2022-27-AS-KHOS-CBVKMN-20220222070150

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700067
Report Date: 01/05/2022
Date Signed: 02/21/2022 09:58:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/02/2021 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20211102224129

FACILITY NAME:	HOSPITALITY HOUSE		FACILITY NUMBER:	342700067
ADMINISTRATOR:	LORRAINE PADILLA		FACILITY TYPE:	740
ADDRESS:	5400 KIERNAN AVENUE		TELEPHONE:	(209) 543-9275
CITY:	SALIDA	STATE: CA	ZIP CODE:	95368
CAPACITY:	80	CENSUS: 51	DATE:	01/05/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Lorraine Padilla		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Medications not given as prescribed
There is not enough staff to meet the needs of residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) made an unannounced visit to the facility on 01/05/2022 at 09:00 a.m. to investigate the allegations listed above. LPA met with Administrator Lorraine Padilla and explained the purpose for today’s visit.

. Regarding the allegations medications not given as prescribed. LPA interviewed 7 facility residents and 1 facility staff. Staff 1 stated she does believe all residents are given medications correctly. Resident 1 stated he did have an issue with not receiving medications ordered timely, and Resident 4 stated she does not receive all medications on time. Two facility residents interviewed stated they are given medications timely, and 3 residents did not mention medications during the interview. LPA reviewed facility Medication Administration Records (MAR) and it showed all medications given to residents timely, and correctly. Therefore, the allegation is deemed UNSUBSTANTIATED. A finding that the complaint 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 did or did not occur, therefore the allegation is unsubstantiated.
Continued on 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

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 4

Control Number 27-AS-20211102224129

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: HOSPITALITY HOUSE	FACILITY NUMBER: 342700067
	VISIT DATE: 01/05/2022

NARRATIVE

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Continued from 9099....

Regarding the allegations there is not enough staff to meet the needs of residents in care. LPA reviewed
facility staff schedule for the month of December 2021.The staffing schedule shows the facility consistently has two caregivers in memory care, 1 to 2 caregivers in assisted living along with a medication technician. The facility Administrator and Resident Care Coordinator can also assist with any urgent Resident needs. LPA has made several visits to the facility recently and observed sufficient staffing levels. Therefore, the allegation is deemed UNSUBSTANTIATED. A finding that the complaint 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 did or did not occur, therefore the allegation is unsubstantiated.

This is an amended report.....

Per title 22 no deficiencies being cited during this visit. Exit interview was conducted with Administrator Lorraine Padilla and a copy of this report was emailed. .

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/02/2021 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20211102224129

FACILITY NAME:	HOSPITALITY HOUSE		FACILITY NUMBER:	342700067
ADMINISTRATOR:	LORRAINE PADILLA		FACILITY TYPE:	740
ADDRESS:	5400 KIERNAN AVENUE		TELEPHONE:	(209) 543-9275
CITY:	SALIDA	STATE: CA	ZIP CODE:	95368
CAPACITY:	80	CENSUS: 51	DATE:	01/05/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Lorraine Padilla		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility is not providing incontinent care
Staff do not treat residents with respect and dignity

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

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 27-AS-20211102224129

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: HOSPITALITY HOUSE	FACILITY NUMBER: 342700067
	VISIT DATE: 01/05/2022

NARRATIVE

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Continued from 9099A....

Regarding the allegations Facility is not providing incontinent care. Based on a previous complaint LPA interviewed 4 facility residents all stated they have waited 30 minutes or more to have their incontinent needs met. Therefore, this allegation is SUBSTANTIATED. No further citations will be issued during this visit for this allegation as the facility was cited on 01/05/2022 for managed incontinence regarding a similar allegation.

Per title 22 no deficiencies being cited during this visit. Exit interview was conducted with Administrator Lorraine Padilla and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4