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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700111
Report Date: 02/19/2025
Date Signed: 02/19/2025 05:48:47 PM

Substantiated


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
11/18/2024 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20241118221048
FACILITY NAME:DELICATE STEMS FOR THE ELDERLYFACILITY NUMBER:
342700111
ADMINISTRATOR:LAURA DOXANFACILITY TYPE:
740
ADDRESS:7008 HERSHBERGER COURTTELEPHONE:
(916) 370-2417
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:5CENSUS: 3DATE:
02/19/2025
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Laura Doxan, Administrator TIME COMPLETED:
05:50 PM
ALLEGATION(S):
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Staff mismanaged resident medication.
Staff did not provide resident's authorized person a copy of the Admission Agreement
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver complaint findings for a complaint received on November 18, 2024. LPA met with caregiver, Allet Levy, and stated the reason for today's inspection. The Administrator, Laura Doxan, was contacted and arrived at 4:25 pm.
LPA observed (1) resident in the common area and (2) were resting in their rooms.

During the course of the investigation, LPA interviewed (2) Administrators, (1) caregiver, (3) hospice personnel, and (1) resident (R2). LPA reviewed documentation related to resident (R1), including, but not limited to, physician's report, hospice medication orders, hospice medication administration documentation, admission agreement, and a detailed summary of the allegations submitted by resident's family member. The resuls of the investigation are as follows:

Resident (R1) moved to the facility on September 5, 2024 with a diagnosis of Hypothyroidism, Diabetes Mellitus Type 2, Mild Cognitive Impairment, showed verbal outbursts at times, and was able to transfer independently to/from bed. (R1) was admitted to hospice services on September 11, 2024 and passed on October 14, 2024. *cont on 9099C-1..
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
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 10
Control Number 59-AS-20241118221048
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: DELICATE STEMS FOR THE ELDERLY
FACILITY NUMBER: 342700111
VISIT DATE: 02/19/2025
NARRATIVE
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9099C-1.. Allegation: Staff mismanaged resident medication. The allegation lists (3) concerns as follows: 1. When family visited on Saturday, October 12, 2024, it was discovered that no pain medication had been administered to resident (R1) for at least (16) to (17) hours overnight during active dying; 2- The Administrator had reluctance to administer drugs against hospice nurse advise; 3- Emergency prescription had to be filled by family member. Facility did not ensure sufficient Lorazepam was available resulting in a family member having to arrange an emergency prescription with hospice and driving to the pharmacy to fill it on Sun October, 13, 2024.

1- Hospice orders show Methadone 2.5 mg was prescribed on September 11, 2024, when hospice was initiated, and resident was to take 1 tablet, by mouth, 2 times daily for pain- once in am and once in pm. Additionally, LPA reviewed an e-mail letter sent from a hospice RN to the facility Administrator, on September 11, 2024 (7:57 pm), that the hospice doctor spoke to (R1's) family member/Medical POA who agrees to start Methadone, in place of Oxycodone 10 mg, on September 12, 2024, and a follow up RN nurse visit was scheduled on Friday, September 13, 2024, to "assess how well methadone is working to control pain and if any changes are needed" and "to ensure that patient and caregivers have the medications needed to ensure patient is able to stay comfortable at RCFE". The letter states that Methadone 2.5 mg tablets and other medications, will be ordered to be delivered the next day, September 12, 2024.

The Centrally Stored Medication and Destruction Record (LIC622) shows Methadone 5 mg (1/2 tablet 2 times daily) was started on 9/13/24, and a new order of Methadone 5 mg- 1.5 tablets to be given twice daily; however, the start date is not documented. This new order is listed after an entry for the medication, Lorazepam, that started on September 28, 2024 and before an entry a medication noted to have started on October 4, 2024. The next entry for Methadone (Morphine) was documented with a start date of October 11, 2024 and for the dosage of 20 mg, or 1 ml, to be given every 2 hours as a PRN.

LPA reviewed documentation of the hospice medications, Morphine and Lorazepam, that were administered starting on October 11, 2024. This documentation shows that a first dose (1 syringe of .25 ml) was given on October 11, 2024 (8:30 pm). The next dose (1 syringe of 1 ml) was given on October 12, 2024, (11:49 am), by a family member, 15 hours after the first dose. Dosages of .5 ml were consistently given every 2 hours throughout the day and next day, on October 13, 2024, including twice by a hospice nurse. The administered morphine dose was increased to 1.0 ml on October 12, 2024 (2:00 pm), due to pain, and was given by a hospice nurse. (R1) received four additional 1 ml dosages, every hour hours, with the last dose given on October 14, 2024 (6:00 am) prior to resident passing at 9:45 am that day. *cont on 9099C-2...

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 10
Control Number 59-AS-20241118221048
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: DELICATE STEMS FOR THE ELDERLY
FACILITY NUMBER: 342700111
VISIT DATE: 02/19/2025
NARRATIVE
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9099C-2.. On September 17, 2024, an order was written to increase the medication Lorazepam 1 mg, and to give 1 tablet by mouth at bedtime for insomnia and anxiety. A PRN order was added on September 27, 2024 to administer Lorazepam 1mg tablet, every 4 hours, as follows: .5 tab for mild, 1 mg (1 tablet) for moderate or 2 mg (2 tabs) for severe anxiety or agitation

The first documented dose of Lorazepam was administered on October 12, 2024 and notes that .5 mg was administered at 2:30 pm and a second dose of .5 mg was administered on October 12, 2024 at 6:30 pm. At 10:30 pm on October 12, 2024, 1.5 mg were administered, and then 4 hours later, .5 mg was given at 2:30 am. An additional 1.5 mg was given on October 13, 2024 at 6:30 am. Facility documentation shows that Lorazepam was continued to be administered throughout the day and evening on October 13, 2024, with the last dose being given on October 14, 2024 at 7:00 am, prior to resident passing at 9:45 am.

Based on methadone not being administered as ordered, during the night of October 11-12, 2024, LPA finds this portion of the allegation to be SUBSTANTIATED.

2- The Administrator had reluctance to administer drugs against hospice nurse advise.
The Administrator stated she had no reluctance to administer hospice medications and stated "I followed hospice orders, (R1) was not in pain and rested most of the time". A hospice staff stated to LPA that (R1's) POA's decision to administer morphine was "in line with hospice care comfort". This staff stated the Administrator indicated to the hospice agency that (R1) was not in pain most of the time, explaining that although an individual "may look okay", but when that person is "repositioned they can express discomfort". This staff commented "it's our approach for facilities to follow doctor's orders and be proactive", stating "typically the dying process is painful" so we want "to be ahead of the pain". This staff further explained "generally we medicate for pain first and anxiety second, but pain can show in the form of anxiety". This staff stated she was surprised to hear the Administrator(s) having discussions about administering medications with another family member, who does not hold Medical POA, since they do not a have a medical license. All who were interviewed stated there was conflict between (R1's) son and daughter. The Administrator stated the son was involving the Administrator about his disagreements.

A second hospice staff was asked if training is provided to facility staff and replied, "yes, we educate on the symptoms of pain, how to reposition and provide comfort, and elevating the legs" and confirmed that morphine orders "were a sliding scale order", based on the level of pain (R1) was experiencing. This staff stated "the facility called us often and said that (R1) was showing symptoms and asked "what should we do", and the facility was told a hospice nurse would come out.
*cont on 9099C-3...
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 10
Control Number 59-AS-20241118221048
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: DELICATE STEMS FOR THE ELDERLY
FACILITY NUMBER: 342700111
VISIT DATE: 02/19/2025
NARRATIVE
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9099C-3.. 3- Emergency prescription had to be filled by family member. Facility did not ensure sufficient Lorazepam was available resulting in a family member having to arrange an emergency prescription with hospice and driving to the pharmacy to fill it on Sun October, 13, 2024.

The Administrator stated she was in regular communication with the hospice nurse and the POA about all the medications, and for (R1), the family was in charge of picking up the prescriptions/refills that hospice ordered. The Administrator stated that each time hospice nurse would visit, they would check the medication supplies and place the refill order and communicate that to the POA first and then the Administrator. The Administrator stated that the refill order must have been called into a pharmacy that didn't do a home delivery on Sunday and confirmed one of (R1's) family member did go to the local pharmacy to pick up a refill prescription of Lorazapem on Sunday, October 13, 2024.

Facility records show the first documented dose of Lorazepam .5 mg was administered on October 12, 2024 (2:30 pm) and a second dose of .5 mg was administered on October 12, 2024 (6:30 pm). At 10:30 pm on October 12, 2024, 1.5 mg was administered, and then 4 hours later, .5 mg was given at 2:30 am. An additional 1.5 mg was given on October 13, 2024 (6:30 am). Facility documentation shows that Lorazepam was administered throughout the day and evening on October 13, 2024, with the last dose administered on October 14, 2024 (7:00 am), prior to resident passing at 9:52 am.

The LIC622 shows the following: Lorazepam 1 mg (7 tablets) was filled on September 12, 2024 and started on September 13, 2024; an order of Lorazepam 1 mg (18 tablets) was filled on September 19, 2024 and started on September 21, 2024; an order of Lorazepam 1 mg (30 tablets) was filled on September 27,2024, and started on September 28, 2024. There were no subsequent orders logged for Lorazepam.

Since hospice was responsible for calling in the refill and communicating with the family and facility, this portion of the allegation is found to be unsubstantiated.

Based on information obtained, LPA finds the allegation "Staff mismanaged resident medication" 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.

*cont on 9099C-4..
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 10
Control Number 59-AS-20241118221048
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: DELICATE STEMS FOR THE ELDERLY
FACILITY NUMBER: 342700111
VISIT DATE: 02/19/2025
NARRATIVE
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9099C-4... Allegation: Staff did not provide resident's authorized person a copy of the Admission Agreement. The allegation states that an admission agreement was not provided or signed and visiting hours and policies were not clearly outlined or explained.

LPA reviewed (R1's) admission agreement on file and observed it to be the original copy and signed and dated by (R1's) family member/POA and the Administrator on September 5, 2024, the day (R1) moved in. The Administrator stated she is "not 100% sure" if a copy of the Admission Agreement was provided to resident's (R1's) POA that day, but believes she provided a copy within the next week. LPA reviewed (3) additional resident files (R3, R4 and R5) on February 13, 2025 and observed each file to contain an original agreement that was signed and dated by each resident's responsible person and the Administrator. The Administrator stated she could recall that a copy was given to these residents' representatives and acknowledged there isn't a system in place to document when a copy is given to each resident and/or their responsible person.

The Visiting Policy, as stated in the Admission Agreement for (R1), reads: "Family and friends are encouraged to visit from 10:00 am to 6:00 pm, Monday through Friday and Saturday, 11 am - 5pm. Every effort will be made to accommodate special requests for visitation at any time as long as the visitation does not violate another resident's personal rights".

The Administrator acknowledged that the facility is open for visitation by family and friends each day and would update the admission agreement to reflect Sunday's hours as 11 am- 5 pm. The Administrator also stated that she did not post the visiting hours until after resident (R1) passed, on October 14, 2024, due to the concerns that arose with multiple visitors arriving at the facility at one time, for extended periods of time and for many consecutive days. The Administrator stated there are not any restrictions on the size of a visiting group, as long as other resident's rights are not violated, and has installed non-audio cameras tinhe common areas.

Based on information obtained, LPA 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.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (2) citations are issued on the 9099-D page. Exit interview with the Administrator. Copy of report and appeal rights provided
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 10 of 10
Control Number 59-AS-20241118221048
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: DELICATE STEMS FOR THE ELDERLY
FACILITY NUMBER: 342700111
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2025
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(4) The licensee shall assist residents with self-administered medications as needed.
This requirement is not met as evidenced by:

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Licensee/Administrator agree to read Regulation 87633 Hospice Care of Terminally Ill Residents and submit a signed statement it is understood.

Licensee/Administrator to ensure that hosice provide the facility with a copy of any documented instructions or changes, including frequency and prescription dose and any other instructions, or orders, after every visit.

Plan to be submitted by 2/21/25 (5pm)
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Based on documentation reviewed, the Licensee did not ensure that resident (R1) received the medication, Methadone (Morphine) as ordered, after 8:30 pm, on Oct 11, 2024 until 11:49 am on October 12, 2024 , or for approximately 15 hours, which posed an immediate health and safety risk to residents in care.


,which posed an immedaite
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Administrator is looking into obtaining an electronic system for charting resident changes, phone communications and how to properly complete the LIC622 and MAR.
Type B
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Section Cited
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87507 Admission Agreements (e) The licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative, if any, immediately upon signing the admission agreement or modification. The licensee shall provide additional copies to the resident or resident’s representative upon request. This requirement is not met as evidenced by:
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Licensee/Administrator agree to develop a system to document when a signed copy of the Admission Agreement is provided to each resident or responsible person.
Admin to submit a form that you will use to document resident/responsible person's signature that a copy was given.

Also agrees to post a blank copy of the Admission Agreement in common area.
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Based on documentation reviewed and interviews conducted, the Licensee did not ensure that a copy of (R1's) signed admission agreement was given to (R1's) POA, on 9/5/24, which posed a potential health and safety risk to residents in care.
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Visiting hours have been posted and there is also a posting that all visitors must sign in upon arriving/departing from the facility.
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: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 9 of 10
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
11/18/2024 and conducted by Evaluator Sabrina Calzada
COMPLAINT CONTROL NUMBER: 59-AS-20241118221048

FACILITY NAME:DELICATE STEMS FOR THE ELDERLYFACILITY NUMBER:
342700111
ADMINISTRATOR:LAURA DOXANFACILITY TYPE:
740
ADDRESS:7008 HERSHBERGER COURTTELEPHONE:
(916) 370-2417
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:5CENSUS: DATE:
02/19/2025
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Laura Doxan, Administrator TIME COMPLETED:
05:50 PM
ALLEGATION(S):
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Staff interfered with resident's visits.
Insufficient staffing to meet resident needs.
INVESTIGATION FINDINGS:
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During the course of the investigation, LPA interviewed the Administrators, (1) caregivers, (3) hospice personnel, and (1) resident (R2). LPA reviewed documentation related to resident (R1), including, but not limited to, physician's report, admission agreement, and a detailed summary of the allegations submitted by resident's family member. The resuls of the investigation are as follows:

Allegation: Staff interfered with resident's visits. The allegation states 1-the Administrator asked resident (R1's) family/visitors to leave when (R1) was in the final stages of active dying and 2- The Administrator demanded that (R1's) possessions be removed less than 24 hours after (R1) passing and put them in trash bags. The results of the investigation are as follows:

1- (R1's) family member/POA stated that while the faciltiy had "initially been accomodating, inviting the family to "make themselves at home" and to visit whenever they wanted, on October 13, 2024 (around 6:00 pm), the Administrator asked the family to "respect visiting hours" and leave, and to not return until 10:00 am the following day. *cont on 9099A-C-1...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 10
Control Number 59-AS-20241118221048
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: DELICATE STEMS FOR THE ELDERLY
FACILITY NUMBER: 342700111
VISIT DATE: 02/19/2025
NARRATIVE
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9099A-C-1... The detailed summary provided by the family member/POA states that the Administrator was informed that (R1) was in the "final hours" due to physical changes and that (R1) had expressed a wish to be surrounded by family in her final hours, and this was previously discussed with the Administrator. The summary explains that the Administrator stated a family member of another resident had complained and then was told that due to "licensing requirements", visiting hours were 10 am - 6 pm, which wasn't explained before.

The Co-Administrator stated that (R1's) visitors would "constantly visit in groups of 6-8 people at a time and refused to sign in at times". The Co-Administrator stated that she and the Administrator were "trying to be nice" and allowed some family member spent the night, adding that she reached out to the family member of (R1's) roommate to ask if they could temporarily be moved to another room that was vacant so (R1's) family could have more space in the room during (R1's) final hours.

Both the Co-Administrator and Administrator stated that they "accommodated them (guests) with food- they were here for a week - constantly- about 6 of then, explaining "they were a large group , walking in and out, and they didn't arrive at once". Both Administrators stated that after about 3-4 days of multiple guests visiting, from early in the morning to late at night, she asked the guests to be "be mindful as there are other residents" at the care home, and the guests were being "loud at the table, in the backyard and all arriving in groups". The Administrators stated it was at this point that some of the guests began to have negative interactions with them. The Administrator stated she "told them they can stay as a group until 10:00 pm initially and then 3-4 days later I told them 8:00 pm", commenting, "I kept making an exception for them".

Another resident (R2) who lived in the care home during the time (R1) lived there, stated to LPA on November 26, 2024 "(R1) had all her relatives here- 5 or more- they stayed from the morning, all day, for about 12 hours", asserting "they made a lot of noise and we couldn't get any rest". (R2) stated "it bothered me- they were going over medical records" and this happened for "2-3 days before (R1) passed, starting early in the morning, and they didn't leave until late in the evening".

(S1) stated that (R1) had a "bunch of visitors" who would arrive around 7:00 am and stay until 12:00 midnight, for several days, and "some visitors stayed the night". This staff confirmed that "most visitors refused to sign in". Hospice staff were unable to provide any information on (R1's) visitors.
*cont on 9099A-C-2
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 10
Control Number 59-AS-20241118221048
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: DELICATE STEMS FOR THE ELDERLY
FACILITY NUMBER: 342700111
VISIT DATE: 02/19/2025
NARRATIVE
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9099A-C-2.. The Visiting Policy, as stated in the Admission Agreement for (R1), reads: "Family and friends are encouraged to visit from 10:00 am to 6:00 pm, Monday through Friday and Saturday, 11 am - 5pm. Every effort will be made to accommodate special requests for visitation at any time as long as the visitation does not violate another resident's personal rights".

The Administrator stated she discussed the visitation policy with (R1's) family member/POA when reviewing and signing the Admission Agreement, upon (R1) moving to the facility on September 5, 2024. A citation is being issued in this report for the facility for not providing a copy of the signed admission agreement.

Based on information obtained, LPA finds this portion of the allegation to be unsubstantiated.

2- The Administrator demanded that (R1's) possessions be removed less than 24 hours after (R1) passing and put them in trash bags.

The family member/POA documented that in the afternoon, following (R1's) passing on October 14, 2024 (9:52 am), she informed the caregiver, (S1), that she and others would be back to collect (R1's) belongings "over the next few days" and (S1) was agreeable. The family member/POA stated she received a text later that evening from the Administrator requesting she arrive between 7 am- 8 am or between 5 pm and 6 pm, tomorrow to pick up the belongings, to which she agreed she would be there in the morning time. The family member stated that upon arriving at 8:00 am, on October 15, 2024, (R1's) belongings had been placed "carelessly in trash bags", ready to be picked up.

The Administrator stated she did not touch anything until the family arrived the next day to pick up (R1's) items, asserting "I asked if they needed help and they said "No". The Administrator added, "there were three to four of them that came to pack up the belongings" and the "POA showed up early and brought bags and boxes" to pack (R1's) things".

LPA spoke to a second family member who confirmed they visited the care home on October 12-13,2024 but was not sure about how (R1's) belongings were packed or picked up.

Based on information obtained, LPA finds this portion of the allegation to be unsubstantiated.
*cont on 9099A-C-3...
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 10
Control Number 59-AS-20241118221048
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: DELICATE STEMS FOR THE ELDERLY
FACILITY NUMBER: 342700111
VISIT DATE: 02/19/2025
NARRATIVE
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9099A-C-3... Allegation: Insufficient staffing to meet resident needs. The allegation states that due to insufficient staffing family members were asked to lift, change, and carry out other tasks for resident (R1).

The Co-Administrator stated there were (3) additional residents present when (R1) resided at the care home, and there were (2) staff on duty, asserting "we are not understaffed".

The Administrator stated there is always 1-2 staff and at least (1) administrator during the day time hours, and during the evening, there is always (1) staff who is awake and sometimes (1) administrator is present.

The Administrator stated she and another care staff would always lift, change and reposition (R1). The administrator stated that (R1's) immediate family regularly offered to assist with repositioning while (R1) was being changed and did so once.

Currently there are (3) residents at the care home with (1) resident under hospice care. LPA observed (1) care staff present when the Administrator arrived. At times, (2) staff are present, depending on the amount of residents.

A second family member there was never a time when (R1) was not receiving the care she needed and staff cared for (R1) well and (R1) was very happy until they began declining.

Based on information obtained, LPA finds this portion of the allegation to be unsubstantiated.

Based on information obtained, the above allegation is found to be 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 occurred.

Exit interview. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 10