342700186-7-28-2022-25-AS-KMKY-CD8LTB-20220406090200

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700186
Report Date: 07/21/2021
Date Signed: 07/28/2022 04:07:42 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
07/21/2021 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210721115341

FACILITY NAME:	WALNUT HOUSE		FACILITY NUMBER:	342700186
ADMINISTRATOR:	LACY BERRY		FACILITY TYPE:	740
ADDRESS:	3401 WALNUT AVE		TELEPHONE:	(916) 483-6612
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	110	CENSUS: 54	DATE:	07/21/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Lacy Berry, Administrator		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Staff is interfering with residents council meetings

INVESTIGATION FINDINGS:

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***This report was amended on 7/28/2022 on the 9099-C page to include some additional information pertaining to the facility's interference with the Resident Council meeting held on 7/9/2021. The 9099-D page was also amended to remove unrelated information***.

**This report is being amended on 8/4/2021 to indicate that on 7/21/2021 the department conducted a 10-day inspection to commence a new complaint investigation. Only the first sentence of the first paragraph, below, has been changed. There are no other changes being made to the report**.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to attend a scheduled meeting and conduct 10-day on a complaint that was received also on 7/21/2021. LPA met with Lacy Berry, Administrator, and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, contacted the facility to confirm there are currently no positive Covid-19 diagnoses, completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and completed a facility risk assessment. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn:surgical Mask.

During today's inspection, LPA attended a scheduled meeting held at the facility from 11:00 am- 12:00 pm between (2) Ombudsman representatives, (3) residents who are on the Resident Council, (1) resident representative, and Administrator to discuss concerns brought to the Ombudsmans' attention by residents following a recent resident council meeting held on 7/9/2021. LPA also interviewd another staff member following the scheduled meeting regarding her role in resident council meetings.
cont on 9099C..

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022

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 25-AS-20210721115341

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: WALNUT HOUSE	FACILITY NUMBER: 342700186
	VISIT DATE: 07/21/2021

NARRATIVE

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It was confirmed from today's scheduled meeting with the Ombudmsan that ballots were passed out to all residents on 6/18/2021 and were due by 7/7/2021. The ballot used was entitled "Nominations for Resident Council Meeting" and instructed residents to make their selection for each of the (4) officers listed and selections were to be written in as no names were pre-listed. The Administrator stated on 7/21/2021 that many residents expressed their reasons and discontent to her about the election not being valid and fair. The Ombudsman stated to the Administrator that if there are residents who are unhappy and/or have concerns with how the resident council is functioning, those residents can contact the Ombudsman's office for assistance and request the Ombudsman attend future resident council meetings. LPA and Ombudsman stressed that the facility role is to encourage and assist residents in the formation, operation and promotion of its council. Ombudsman provided Administrator with a copy of Rights of Resident Councils, based on Health and Safety Code §1569.157 and explained that any (2) residents can start a resident council and have the right to hold meetings without any facility staff attendance or interference. Resident (R1) who was nominated "President" stated that (13) ballot responses were received and when their follow up meeting was held on 7/9/2021, the Administrator, staff (S1) and a corporate staff member attended and disbanded the meeting, and eliminated the vote, saying that not enough residents had voted, and a new election would be needed.

Residents (R1/R2) provided additional information on 10/19/2021 that at the start of the resident council meeting on 7/9/2021, the owner informed the residents that the Administrator was in charge of the meeting and staff (S1) was there to take notes. Residents (R1/R2) stated to LPA they had invited the Administrator and the owner, who indicated that his mother would probably like to attend the meeting, but they did not invite staff (S1) as they did not feel it was necessary to have her attend since she was not a manager or a person able to make changes at the facility. The Administrator stated to LPA on 10/19/2021 that both she and the owner had been invited to the meeting on 7/9/2021 by R1 but that staff (S1) attended and "took notes as a courtesy", as it had been done at prior resident council meetings. Staff (S1) stated to LPA on 7/21/2021 that corporate facility staff instructed her to be present at the resident council meeting, on 7/9/2021, to take meeting notes and because she and the Administrator were also attending. Staff (S1) further stated that multiple residents who attended the meeting were upset due to not being able to complete a ballot and not being comfortable with elected board members on the resident council.

Additionally, it was learned through interviews that residents were instructed by the facility to print their first and last names on the ballots at the meeting on 7/9/2021.

Based on information obtained, LPA finds the allegation "Staff is interfering with residents council meetings" 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.

Exit interview. Copy of report and appeal rights printed and provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 25-AS-20210721115341

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: WALNUT HOUSE	FACILITY NUMBER: 342700186
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/21/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 08/04/2021 Section Cited HSC 1569.157(g)	1 2 3 4 5 6 7	§1569.157 Resident-oriented facility council (g) A facility shall not willfully interfere with the formation, maintenance, or promotion of a resident council, or its participation in the regulatory inspection process. For the purposes of this subdivision, willful interference shall include, but not be limited to, discrimination or retaliation in any way against an individual as a result of his or her participation in a resident council, refusal to publicize resident council meetings or provide appropriate space for either meetings or a bulletin board, or failure to respond to written requests by the resident council in a timely manner. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator agree to read Health and Safety Code 1569.157 with facility staff and send a signed statement that the code is understood by staff. Documentation to be Faxed to CCLD by 8/4/2021.
	8 9 10 11 12 13 14	Based on interviews conducted, the Licensee did not ensure that the facility did not willfully interfere as multiple facility staff attended a resident council meeting, held on 7/9/2021, and took control and adjourned the meeting and didn't allow the residents to lead their meeting, which posed a potential personal rights violation to residents in care.	8 9 10 11 12 13 14
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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: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC9099 (FAS) - (06/04)

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