342700073-1-3-2022-25-AS-MSEY-CACNAX-20220104091813

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700073
Report Date: 01/03/2022
Date Signed: 01/03/2022 01:03:21 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/29/2021 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20211129094359

FACILITY NAME:	PEOPLE'S CARE WINFIN		FACILITY NUMBER:	342700073
ADMINISTRATOR:	NARITIA COLLINS		FACILITY TYPE:	735
ADDRESS:	3418 WINFIN WAY		TELEPHONE:	(916) 480-9660
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	4	CENSUS: 4	DATE:	01/03/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Denise Mc Elveen, DSP		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is not reporting covid positive cases
Facility is not performing daily screening of staff or clients
Facility is not testing per guidelines

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint received on 11/29/2021. LPA met with Denise Mc Elveen, DSP, and explained purpose of inspection. Administrator arrived shortly to the facility. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, confirmed there are currently no positive Covid-19 diagnoses, and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA observed DSP Tanissa Broadus, LVN, Aimerance Mande and DSP, Quiona Jones also present during today's inspection.

During the course of the investigation, LPA interviewed the Administrator, contacted Alta California Regional Center (ACRC) and local public health and reviewed documentation including: client and staff self-screening logs and and Covid-19 testing records.

The results of the investigation are as follows:

Cont on 9099-C..

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021

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-20211129094359

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: PEOPLE'S CARE WINFIN	FACILITY NUMBER: 342700073
	VISIT DATE: 01/03/2022

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

9099C(1).. LPA interviewed the Administrator on 12/2/2021, when conducting the 10-day inspection, who confirmed there were (3) positive staff cases of Covid-19 on the following days: Staff (S1) received a positive test result on 5/26/2021; staff (S2) received a positive test result on 9/7/2021; and Staff (S3) received a positive test result on 11/16/2021.

Administrator stated the positive cases were not reported to the Department or to local public health but were reported to the regional center. Administrator stated she was not aware that one positive case needed to be reported, but that only if there were two or more cases. LPA received information from ACRC that they do not have a record of any positive Covid-19 cases having been reported for 2021. LPA confirmed with local public health that per All Facilities Letter (AFL) 20-75.1 issued 7/22/2021, an outbreak for Long-Term Care Facilities is defined as "one or more facility-acquired Covid-19 case in a resident".

Provider Information Notice (PIN) 20-04 issued 3/5/2020 states that facilities are to contact local public health immediately if there is a confirmed case and/or suspected outbreak of Covid-19 in the facility.
Multiple clients (4) were potentially exposed and placed at risk, on (3) separate occasions, when individual positive staff cases of Covid-19 were not reported within 24 hours to the Department.

Based on information obtained, the Department finds the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Allegation: Facility is not performing daily screening of staff or clients. LPA reviewed staff temperature logs that were completed showing recorded temperatures and any screening symptoms for Covid-19 for the period 2/25/2021 -12/2/2021. LPA reviewed resident temperature logs and observed them to be complete for months January - March 2021, partially complete for months October- November 2020, and there was no documentation available prior to October 2020. Administrator stated that resident/client temperatures were stopped in March 2021 and not taken again until October 2021. During this same time period, the facility had (2) staff test positive for Covid-19- in May and in September, 2021. PIN 20-38 issued 10/6/2020 provides updated guidance that if testing cannot be done per PIN 20-23, issued 6/26/2020, residents who are asymptomatic and who have not been exposed to a person with COVID-19 should be screened, at least on a daily basis, for fever, respiratory symptoms, or common symptoms of possible COVID-19 infection.

Based on information obtained, the Department finds the portion of the allegation pertaining to clients to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 25-AS-20211129094359

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: PEOPLE'S CARE WINFIN	FACILITY NUMBER: 342700073
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/03/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/03/2022 Section Cited CCR 80061(b)(1)(E)	1 2 3 4 5 6 7	80061 Reporting Requirements (b) Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event. (E) Any unusual incident or client absence which threatens the physical or emotional health or safety of any client. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator agree to read Regulation 80061 and conduct in-service training. Administrator began maintaining testing records on/around September 2021 and wil continue to do so. Documentation of agenda/attendees to be emailed to the Department by 1/17/2022.
	8 9 10 11 12 13 14	Based on interview with Administrator on 12/2/2021, the Licensee did not ensure that the (3) positive staff Covid-19 cases from 2021 (May, Sept and Nov) were reported to the Department, and to local public health, within 24 hours and a written report was submitted to the Department within (7) days of each confirmed positive case, which poses an immediate health and safety risk to clients in care.	8 9 10 11 12 13 14
Type B 01/13/2022 Section Cited CCR 80072(a)(2)	1 2 3 4 5 6 7	80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator agree to conduct in-service training on required daily screening of clients and documentation of it. Documentation of agenda/attendees to be emailed to the Department by 1/17/2022.
	8 9 10 11 12 13 14	Based on interview with Administrator and documentation reviewed, the Licensee did not ernsure that the facility conducted daily temperature screenings of residents prior to October 2020 and from April- September 2021, which posed a potential health and safety risk to clients 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.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 25-AS-20211129094359

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: PEOPLE'S CARE WINFIN	FACILITY NUMBER: 342700073
	VISIT DATE: 01/03/2022

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: Facility is not testing per guidelines- Specifically, facility is not conducting weekly Covid testing for unvaccinated staff.

PIN 21-28 issued 6/7/2021 states, in part: In facilities where less than 70 percent of residents and facility staff are fully vaccinated, licensees should continue to conduct diagnostic screening testing of 25 percent of all facility staff every seven (7) days consistent with guidance in PIN 20-38.

Administrator stated the facility has always conducted surveillance/25% testing of staff since she took over as Interim Executive Director on/around January/February 2021. Documentation was reviewed showing testing was conducted through an outside lab from Nov 2020- Sept 2021, however, was not consistently done, every week, and varied from one staff to six.

PIN 21-32 issued 7/27/2021 (supersedes PIN 21-28)- requires all facility staff who are unvaccinated or incompletely vaccinated undergo diagnostic screening testing at least once per week and for licensees to verify a negative Covid-19 test, effective 8/9/2021.

Administrator stated she tested 2 staff weekly in August 2021, which was 25% of her staff (8).

On 12/2/2021, LPA was provided with documentation from 9/5/2021 through 12/3/2021, of weekly testing being conducted The documentation shows (3) unvaccinated staff were tested on 9/5/2021 and on 9/7/2021 and response testing was conducted on 9/11/2021 and 9/15/2021, following a positive staff result on 9/7/2021. Additional testing was conducted for unvaccinated staff on 9/23/2021, 9/28/2021, 10/6/2021, 10/19/2021 and on 10/28/2021. Weekly testing was resumed on 11/3/2021, 11/12/2021, 11/16/2021 with response testing being conducted on 11/17/2021 and on 11/23/2021, following a positive test result on 11/16/2021. Weekly testing for unvaccinated staff was done again on 12/3/2021.

LPA was not provided with documentation of weekly testing of unvaccinated staff for period 8/9/2021 through 8/31/2021. Administrator stated it was conducted at a related location due to this location not having a testing contract in place; however, no documentation was available.

Based on information obtained, the Department finds the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Based on California Code of Regulations, Title 22, Division 6, Chapter 8, the following (2) deficiencies are cited.

Exit interview with Administrator by phone. Administrator authorized DSP Denise Mc Elveen to sign today's report. Administrator requested the report be emailed to her.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022

LIC9099 (FAS) - (06/04)

Page: 6 of 6