342700067-1-5-2022-27-AS-KHOS-CAKUU4-20220111145255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700067
Report Date: 01/05/2022
Date Signed: 01/05/2022 10:32:56 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
08/24/2021 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20210824100818

FACILITY NAME:	HOSPITALITY HOUSE		FACILITY NUMBER:	342700067
ADMINISTRATOR:	SONYA SMITH		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:	11:00 AM
MET WITH:	Administrator Lorraine Padilla		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff consumes alcohol on facility premises during working hours.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) made an unannounced visit to the facility on 01/05/2022 at 09:30 a.m. to investigate the allegations listed above. LPA met with Administrator Lorraine Padilla and explained the purpose for today’s visit.

Regarding the allegation that staff consumes alcohol on facility premises during working hours. LPA interviewed several facility staff. The staff could not say they eye witnessed anyone at the facility drinking alcohol but had only heard rumors. 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.

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.

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

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
08/24/2021 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20210824100818

FACILITY NAME:	HOSPITALITY HOUSE		FACILITY NUMBER:	342700067
ADMINISTRATOR:	SONYA SMITH		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:	11:00 AM
MET WITH:	Administrator Lorraine Padilla		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Help pull cord is not accessible to residents.
Resident's diapering needs are not being met resulting in diaper rash.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) made an unannounced visit to the facility on 01/05/2022 at 11:00 a.m. to investigate the allegations listed above. LPA met with Administrator Lorraine Padilla and explained the purpose for today’s visit.

Regarding the allegation that Resident's diapering needs are not being met resulting in diaper rash. Based on interviews with residents and staff the residents diapering needs are not being met timely. LPA interviewed 4 facility residents, and 3 facility staff. The residents all stated they have waited up to 30 minutes mainly in the evenings to have incontinent needs met. The facility staff interviewed also agreed residents are waiting more 30 minutes at times to have their incontinent needs met. As a result of information obtained and the interview conducted 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.

Continued on 9099C...

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-20210824100818

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 allegation the help pull cord is not accessible to residents. Based on LPA interviews with 4 facility residents and 3 facility staff the help pull chord is not always accessible to residents. Resident 1 stated he remembers a specific incident where his roommate fell and could not reach his pull chord. Resident 1 stated he was trying to alert staff by pulling his chord, but no one was coming to help. Resident 1 stated it was later discovered the battery in his alarm didn’t work so no staff was never alerted. Resident 2 stated she was not being assisted after pulling her chord. Resident 2 stated staff told her on several occasions her chord must not be working because they are not being notified when she pulls the chord. Resident 2 stated this happened several times before the facility maintenance person came to fix her chord. As a result of information obtained and the interview conducted 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 deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. An exit interview conducted with Administrator Lorraine Padilla and a copy of this report along with appeal rights 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

Control Number 27-AS-20210824100818

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/05/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/06/2022 Section Cited CCR 87625(b)(2)(3)	1 2 3 4 5 6 7	87625(b)(2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night.(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Administrator will send proof of training to LPA by 01/06/2022 of staff training from an outside source on timely incontinent care.
	8 9 10 11 12 13 14	Based on staff and resident interviews the licensee did not ensure resident incontinence needs are being met in a timely manner, which poses an immediate Health, Safety, or Personal Rights risk to residents in care.	8 9 10 11 12 13 14
Type A 01/06/2022 Section Cited CCR 87303(d)(2)	1 2 3 4 5 6 7	87303(d)(2) Personal Accomodations and Services.(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Administrator will send documents to LPA by POC date of 01/06/2022 detailing a plan to ensure maintnence is checking all chords on a weekly basis.
	8 9 10 11 12 13 14	based on Resident interviews facility pull chords are not always in working order which poses an immediate Health, Safety, or Personal Rights risk to 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: 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 appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

LIC9099 (FAS) - (06/04)

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