342700186-11-17-2022-25-AS-MSEY-CLDLWJ-20221121080710

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700186
Report Date: 11/17/2022
Date Signed: 11/17/2022 01:42:50 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
07/19/2022 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220719143307

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: 61	DATE:	11/17/2022
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Lacy Berry, Administrator		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Residents call bells are not being answered timely

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada and LPA Cassie Yang arrived at the facility unannounced to deliver findings to a complaint received on 7/19/22. LPA's met with Lacy Berry, Adminstrator and explained the purpose of the visit. Prior to initiating the complaint visit, LPA's completed the required COVID-19 protocols. LPA's wore a surgical or N95 mask and were screened by facility staff upon entering the facility.

During the investigation, LPA Calzada interviewed the Administrator, Resident Care Coordinator (RCC) in July 2022, (4) staff, and (11) residents. LPA Calzada reviewed the facility Call Light Report provided for period July 1, 2022 - July 21, 2022 (12: 41 am). LPA received 93 of 126 pages of July 2022 Call Light report by email on 8/4/22.

The results of the investigation are as follows:

cont on 9099C(1)..

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: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

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 9

Control Number 25-AS-20220719143307

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: 11/17/2022

NARRATIVE

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9099C(1).Allegation: Residents call bells are not being answered timely.
Complaint alleges it can take staff an hour or two to respond to call bells, or a resident’s cell phone when the front desk is called, and sometimes the staff don't respond at all.

Call Light report for period July 1, 2022 -July 21, 2022 (12: 41 am) was reviewed. The report indicates the average response time is 21 minutes. While the report lists the average response time as 21.0 minutes for July 2022, there were multiple instances when the call response times were an hour or greater.

Call response times were reviewed for resident (R1). The report shows response times varied during the month and records (3) instances where the response time was between one and two hours. Specifically, on these days/times: July 5, 2022 at 5:26 am- 118.5 minutes; July 14, 2022 at 6:57 am- 70 minutes; and July 20, 2022 at 8:52 pm- 79 minutes.

The report also consistently shows at least one response time to be greater than one hour for other residents on each day of the period reviewed, from July 1- 21, 2022 with several days recording multiple instances of a response time of one to two hours or greater.

R1 stated to LPA that call button response times are the longest during the evenings and during the NOC shift from 11 pm- 7 am and staff don't respond timely when she calls the front desk using her cell phone.

Several (3) residents stated their call button doesn't work and (2) residents stated staff don't often answer when they call the front desk.

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 (1) deficiency is issued on the 9099-D page.

Exit interview. Copy of report and appeal rights provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 9

Control Number 25-AS-20220719143307

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: 11/17/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/01/2022 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator agree to conduct staff traiining on reiterating the importance of resetting the call light button at the time care is provided. Training to be conducted also on communicating with team members about covering all calls, in elvery hall, if a caregiver is busy with another resident or on break, so the call be answered timely. Documentation to be submitted to CCLD by fax/email by 12/9/22.
	8 9 10 11 12 13 14	Based on record review and interviews conducted, the Licensee did not ensure that staff responded timely to resident's (R1) request for assistance when the call button was used on 7/5/22, 7/14/22 and on 7/20/22, which posed a potential health and safety risk and/or personal rights violation to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 9

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
07/19/2022 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220719143307

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:	DATE:	11/17/2022
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:			TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Residents are not being showered timely
Residents laundry is not being done timely
Resident missed medication
Staff are not trained properly on how to assist resident

INVESTIGATION FINDINGS:

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During the investigation, LPA interviewed the Administrator, Resident Care Coordinator (RCC) in July 2022, (4) staff, and (11) residents. LPA reviewed documentation including: shower refusals for July 2022, Medication Administration Record (MAR) for July 2022 for residents (R1 and R2), and staffing schedules for July 2022. The results of the investigation are as follows:

Allegation: Residents are not being showered timely.
Complaint alleges that due to the staffing shortage, residents are not being showered timely. Resident stated she did not receive a shower last week and some residents have not gotten a shower in two weeks.

LPA reviewed shower refusal documentation provided for July 2022 which shows that (6) residents refused showers Reasons listed for resident refusal include: no reason provided, resident not wanting a shower, (2) residents not wanting to take a shower in the shower room due to it being cold, resident ignoring caregiver, and another resident stating she already washed up because staff was not there at 5:30 am, 45 minutes earlier. In all (6) refusals, it is not noted if additional attempts were made after the resident initially refused. Time of day of shower attempts range from 6:00 am- 4:00 pm and occurred on Tuesdays, Wednesdays Thursdays and Saturdays.
cont on 9099A-C(1)...

Unsubstantiated

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: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 9

Control Number 25-AS-20220719143307

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: 11/17/2022

NARRATIVE

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9009A-C(1)... RCC stated on 7/28/22 that sometimes there are issues on the morning shift with showers not being given stating “we rely on (outside agency) and if they are a no-show, then the Med-Tech or RCC helps", and also “the "am" shift is heavy with showers". Administrator and (2) staff stated that a lot of residents do refuse a shower at times and staff will document when a resident refuses. Resident (R2) stated on 7/28/22 "most of the caregivers are from the agency- caregivers used to remind us of the shower day and time", but he now has to “find staff and ask for a shower”. One staff stated a lot of residents refuse a shower if they are tired or watching television with another caregiver stating that a lot of residents can refuse depending on the caregiver. Two additional staff stated that some residents are not given showers because they are not offered one by agency staff who often take long break periods.

One resident who is scheduled for early morning showers on Wednesdays and Saturdays stated on 10/19/22 that he did not receive a shower that morning, but staff told him he could get a shower at 11:00 pm later that day. Another resident stated on 10/19/22 that she missed her shower this last Sunday and staff is on their phone during her shower and staff will shower residents in the middle of the night when it's “freezing cold, so residents will often refuse”. When asked if showers are given timely, another resident stated on 10/19/22 “it depends on the number of staff", commenting that she did not get a shower on Tuesday, and she "never refuses". Two additional residents interviewed on 10/19/22 indicated that sometimes no staff will come by to offer a shower so they don’t receive one with another resident stating she has to ask for a shower. Another resident interviewed on 10/19/22 indicated he is not sure if he receives two showers weekly with a different resident stating she has received only two showers since February 2022 but she received a shower last week. R1 was interviewed on 7/28/22 and stated she only received one shower in the last week due to staff not knowing how to use the “Sarah Stand”. Resident was interviewed again on 10/19/22 and she indicated she received two showers in the last week.

Based on information obtained, LPA finds the allegation 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.

cont on 9099A-C(2)..

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 9

Control Number 25-AS-20220719143307

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: 11/17/2022

NARRATIVE

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9099A-C(2).. Allegation: Residents laundry is not being done timely.
Complaint alleges that laundry is not being done due to the lack of staff.

RCC stated on 7/28/22 that caregivers usually do laundry and it is done on all shifts, am, pm and NOC. RCC also stated she is not aware of laundry being done late; residents' laundry is washed once

weekly, per the schedule, and if it’s missed, staff will try and do it the next shift or next day. Administrator stated on 7/28/22 “residents have a laundry day once per week, to match their shower day” and “CNA’s are doing a good job”. Administrator stated on 10/19/22 that she advises staff they need to finish any laundry started by the end of their shift. R1 stated on 7/28/22 "the only problem is clothes return with holes or stains" and confirmed she gets her own laundry back.

July 2022 staffing schedules show that (3) to (4) caregivers were consistently scheduled on the “am” and “pm” shifts and (2) to (3) caregivers were consistently scheduled for the “NOC” shift.

One staff stated on 7/28/22 “Yes, laundry is done late or mixed up with another resident's" and temp agency staff "is doing the laundry, but they need to finish the laundry and return it to the resident", explaining that clothes are "left in the washer or dryer" for the next shift. Another staff stated on 8/8/22 that it depends on the caregiver if laundry is completed during the shift and that staff from the temp agency will do laundry.

Several other residents interviewed on 10/19/22 stated their laundry is not done timely, is returned wet and/or unfolded, not picked up on shower days, and has been lost or mixed-up with another resident’s laundry. One resident stated that only (2) clothes dryers are working, he has lost (5) pairs of pants, and his laundry is washed but it is not returned or folded timely.

R1 stated to LPA on 10/19/22 that her laundry was done last night. During the same interview, LPA observed only clean laundry in R1's clean laundry bin and the dirty laundry bin to be empty.

Based on information obtained, LPA finds the allegation 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.
cont on 9099A-C(3)..

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC9099 (FAS) - (06/04)

Page: 6 of 9

Control Number 25-AS-20220719143307

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: 11/17/2022

NARRATIVE

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9099A-C(3)... Allegation: Resident missed medication.
Complaint alleges that on 7/18/22, the staff did not give resident her after dinner medications.

LPA reviewed the July 2022 MAR for resident (R1) and resident (R2). The MAR shows staff initialed that resident (R1) received (5) of (5) scheduled evening medications and (4) of (4) scheduled bedtime medications on 7/18/22. LPA reviewed all medications for R1 for July 2022 and all medications were initialed as being administered as ordered except for medication Lamictal 25 mg which was ordered to be given once by mouth every morning for (14) days, effective 4/12/22, and then twice a day. MAR is initialed that all dosages were administered as ordered in the morning; however, is not initialed on the following (6) days in July 2022: 7/2, 7/4, 7/8, 7/14, 7/20, and 7/26. Staffing schedule for July 2022 shows staff (S1) worked on 7/4/22 and staff (S2) worked on the remaining days where the MAR was not initialed. Prior Department interviews show S1 has worked at the facility as a Med-Tech for several years, and S2 stated to LPA on 7/28/22 that she is a “Med-Tech in training”. Since there were not consecutive days where the MAR was not initialed, It is likely that the omission on the MAR for the day S1 worked is due to an oversight, and the omissions on the days S2 worked may be due to S2 being a a Med-Tech in training at that time. Neither S1 and S2 were interviewed during the investigation specifically about these omissions on the MAR. Administrator stated after dinner medications are probably referring to PRN medications which are only given when requested, and it's possible the resident expected to administer PRN medications as if they were routine medications.

R1 stated in an interview to LPA on 7/28/22 that she takes the medication, Lasix and gets 40 mg in the morning and that she isn’t sure she was administered this medication today, explaining it is a small white pill. MAR shows Lasix was administered on 7/28/22 in the morning. R1 also stated that the Resident Care Coordinator told her on Monday, 7/25/22, the medication refill hadn't come in, commenting she is not sure if other meds are missing. MAR for July 2022 shows an “x” was entered in place of staff initials on 7/25/22, designating the medication is “on hold”. LPA observed (2) scheduled medications, Wellbutrin 150 mg and Aspirin 81 mg, for R1 to have unclear markings with a circle on the MAR for 7/25/22 and 7/26/22 for morning and noon dosages, making it unclear if the medication was given.

R2 stated on 7/28/22 that he may have missed medications if the doctor doesn’t refill the medication. MAR for July 2022 notes staff initials were entered for every dosage ordered except for Carbidopa- Levodopa 25-100 mg for the noon dosage; however, there are staff initials indicating the medication was administered for the pm and bedtime dosage on the same day, so the medication had not run out.
cont on 9099A-C(4)....

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC9099 (FAS) - (06/04)

Page: 7 of 9

Control Number 25-AS-20220719143307

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: 11/17/2022

NARRATIVE

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9099A-C(4)..RCC stated on 7/28/22 that the facility is currently short staffed with Med-Techs, but she and the Administrator can cover and administer medications. Administrator stated on 10/19/22 she has not heard of any medications not being administered as ordered; however, facility staff cannot refill a PRN medication without the physician’s authorization. Two other staff interviewed on 10/19/22 stated they are not aware of any missed medications, and two residents interviewed on 10/19/22 indicated medications are not given on time if there is not enough staff with one resident stating his medications are "probably" given to him late.

Based on information obtained, LPA finds the allegation 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.

However, an Advisory Note is being issued to document that omissions were observed on the MAR, making it unclear if a medication was given as ordered.

Allegation: Staff are not trained properly on how to assist resident. Complaint alleges that resident has equipment that helps her get up and she must instruct the staff on how to use it.

Resident (R1) stated to LPA on 7/28/22 that her showers are scheduled on Tuesdays and Fridays and confirmed she received a shower two days ago, on Tuesday. R1 asserted that she uses the "Sarah Stand", pointing to a stand in her private bathroom, explaining that the "Sarah Stand" (or Sara Stedy) helps her to get up and get to her wheelchair. R1 confirmed that staff will take her to the shower room for a shower instead of showering her in her private bathroom. R1 continued to explain that she received only (1) shower last week because the temporary caregiver staff was "unsure of herself and how to transfer" R1 from her bed to the wheelchair, asserting "I told staff she needs to use the Sarah Stand", and Physical Therapy staff trained all facility staff in how to use a Sarah Stand.

Resident Care Coordinator stated on 7/28/22 that as far as agency staff, “only the caregivers are trained" and the agency says staff is trained to work in SNF's and in Assisted Living both. Caregivers help with ADL's and "they seem able to do that". RCC indicated that each caregiver is given a resident list with notes and she

(RCC) walks through the building at the start of the shift" and gives training for their shift which includes orienting to residents.
cont on 9099A-C(5)...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC9099 (FAS) - (06/04)

Page: 9 of 9

Control Number 25-AS-20220719143307

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: 11/17/2022

NARRATIVE

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9099A-C(5)..LPA asked Administrator on 7/28/22 what specific training agency staff has. Administrator stated "CNA's have CPR and First Aid” training. When asked if the facility staff gives agency staff additional training, Administrator stated “temp staff will go with one of the Walnut House Staff, and the RCC will give a guide to the temp staff, at the change-over meeting, highlighting the needs of the residents”.

LPA followed up with an interview with R1 on 10/19/22. R1 stated that “now staff are using the "Sarah stand except for (1) Certified Nursing Assistant (CNA) who is still refusing to use the Sarah Stand". One staff stated temp staff need to be trained on the specific resident, stating "a lot of staffing from the agency will return a few times" and at staff cross-over meetings, staff will discuss each resident's care needs- and “agency staff need more training on how to work with the resident". R2 stated on 7/28/22 that agency staff need more training on showers.

Based on information obtained, LPA finds the allegation 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 to the Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC9099 (FAS) - (06/04)

Page: 8 of 9