342700077-7-22-2021-27-AS-MSEY-C5AS9B-20210726134028

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700077
Report Date: 07/22/2021
Date Signed: 07/22/2021 10:47:19 AM

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
02/11/2021 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 27-AS-20210211101204

FACILITY NAME:	COURTE AT CITRUS HEIGHTS, THE		FACILITY NUMBER:	342700077
ADMINISTRATOR:	DAVIS, KAYLA		FACILITY TYPE:	740
ADDRESS:	6825 SUNRISE BLVD		TELEPHONE:	(916) 721-0644
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	48	CENSUS: 21	DATE:	07/22/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Oliver Aden, Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Licensee did not assist residents with basic services
Resident not assisted with incontinence care
Facility did not report scabies outbreak at facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver findings into allegations listed above. LPA met with administrator Oliver Aden upon LPA’s arrival. LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. Additionally, LPA was screened by staff upon entering the facility.
LPA investigated allegation, “Licensee did not assist residents with basic services”. LPA interviewed staff and conducted a record review. Interviews with relevant party indicate that staff do not provide showers to R4 due to their behaviors. LPA interviewed 7 caregivers in which they stated R4 can be aggressive with staff and refuse care.
Continuation on 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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 4

Control Number 27-AS-20210211101204

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: COURTE AT CITRUS HEIGHTS, THE	FACILITY NUMBER: 342700077
	VISIT DATE: 07/22/2021

NARRATIVE

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Staff interviews indicated they offer showers however they are more successful with bed bathes. Staff stated when R4 refuses care they leave the resident and try again later in the day. LPA reviewed R4's charting notes which indicate R4 has a history of aggression and refusal of care. LPA reviewed R4's physician report in which it states resident has a diagnosis of dementia and can be anxious and forgetful at times. According to R4’s LIC602 resident requires assistances with bathing. In addition, LPA reviewed communications with R4’s doctor informing that R4 is refusing showers. Due to the information gathered, LPA finds allegation to be UNSUBSTANTIATED.
LPA investigated allegations, “Resident not assisted with incontinence care”. LPA interviewed staff and reviewed resident documentation. LPA interviewed relevant party in which they stated incontinence care was not provided in a timely manner for resident. LPA interviewed 7 staff members in which they stated R4 can be aggressive and refuse continence care. Staff stated when R4 becomes aggressive they leave resident alone for a short amount of time and try again. Interviews with administrator, Martin Nicols, stated there was one incident in which resident refused care for approximately 2 hours, and were unable to provide continence care until resident calmed down. LPA reviewed R4’s charting notes which indicated resident refused care several times and showed aggressive behavior frequently. LPA reviewed R4 physician report in which it states resident has a diagnosis of dementia and can be anxious and forgetful at times. Due to the information gathered LPA finds allegation to be UNSUBSTANTIATED.
LPA investigated allegation, “Facility did not report scabies outbreak at facility”. LPA interviewed staff and conducted a record review. LPA interviewed relevant party in which they stated residents had scabies in December 2020 and January 2021. LPA reviewed 6 resident charting notes from the facility, and observed 3 of 6 residents had a rash and was prescribed creams or ointments. LPA observed it was noted that R1, R2, and R3 had a rash present in January 2021 and a cream was prescribed for resident however there was no formal diagnosis of scabies. In March 2021 Administrator, Martin Nicols, reported to LPA a scabies outbreak and 11 residents were being treated for scabies. LPA finds facility notes indicate there was a rash on several residents in January 2021 however no formal diagnosis was given, therefore LPA finds allegation to be UNSUBSTANTIATED.
Exit interview conducted.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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, 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
02/11/2021 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 27-AS-20210211101204

FACILITY NAME:	COURTE AT CITRUS HEIGHTS, THE		FACILITY NUMBER:	342700077
ADMINISTRATOR:	DAVIS, KAYLA		FACILITY TYPE:	740
ADDRESS:	6825 SUNRISE BLVD		TELEPHONE:	(916) 721-0644
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	48	CENSUS: 21	DATE:	07/22/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Oliver Aden, Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility did not seek medical care for residents
Facility did not document changes in resident’s condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver findings into allegations listed above. LPA met with administrator Oliver Aden upon LPA’s arrival. LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. Additionally, LPA was screened by staff upon entering the facility.
LPA investigated allegation, “Facility did not seek medical care for residents”. LPA interviewed relevant party in which they indicated facility did not seek medical attention for residents with scabies in December 2020 and January 2021. LPA reviewed 6 residents charting notes, needs and service plan, and physician report. LPA observed 3 of 6 residents had a rash present in January 2021.
Continuation on 9099-C.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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-20210211101204

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: COURTE AT CITRUS HEIGHTS, THE	FACILITY NUMBER: 342700077
	VISIT DATE: 07/22/2021

NARRATIVE

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Documentation shows R1’s hospice nurse was notified of the rash, R2’s documentation shows their physician and later hospice nurse was notified and virtual doctor appointment was held and R3’s documentation shows a virtual doctor appointment was held. In March 2021 Medical Director diagnosed 11 residents with scabies and medication was prescribed. All responsible parties, and physicians were notified. LPA finds allegation to be UNFOUNDED.
LPA investigated allegation, “Facility did not document changes in resident’s condition”. LPA interviewed staff and conducted a record review. LPA interviewed relevant party in which they stated R4's behaviors and changes in condition are not documented. LPA interviewed Resident Care Coordinator and they stated a reappraisal is completed annually and upon change of condition. LPA reviewed R4’s needs and service plan dated 9/30/2020 which indicates the care needed and the behaviors R4 displays. In addition, LPA reviewed R4’s needs and service plan dated 3/20/21 which indicates residents care needs, behaviors, and shows resident is now on hospice care. LPA reviewed R4’s charting notes which documents residents’ behaviors and facilities communication with R4’s physician and hospice team. LPA reviewed R4’s physician report dated on 4/30/20 and resident is now on hospice services. Due to the information gathered, LPA finds allegation to be UNFOUNDED.

Exit interview conducted.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4