342700202-4-22-2022-25-AS-LMUZ-CDW2C8-20220427171619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700202
Report Date: 04/22/2022
Date Signed: 04/22/2022 01:54:31 PM

Unsubstantiated

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
12/08/2021 and conducted by Evaluator DeAnna Williams-Lyons

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20211208162157

FACILITY NAME:	VILLAGE AT HERITAGE PARK, THE		FACILITY NUMBER:	342700202
ADMINISTRATOR:	KAYLA DAVIS		FACILITY TYPE:	740
ADDRESS:	2001 ROSE ARBOR DRIVE		TELEPHONE:	(916) 216-8958
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95835
CAPACITY:	108	CENSUS: 56	DATE:	04/22/2022
		UNANNOUNCED	TIME BEGAN:	11:27 AM
MET WITH:	Kayla Davis, Executive Director		TIME COMPLETED:	02:13 PM

ALLEGATION(S):

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Facility has pests
Staff do not assist residents with bathing
Staff do not assist resident with grooming
Staff do not assist residents with incontinence care
Staff do not reposition residents regularly

INVESTIGATION FINDINGS:

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On April 22 2022, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to deliver findings for complaint # 25-AS-20211208162157. LPA met with Kayla Davis, Executive director, and informed her the reason for the visit.

Prior to the visit, 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; contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks.

The Department received a complaint alleging the facility has pests, facility staff does not assist residents with bathing and grooming, or assist with incontinence needs, and staff do not reposition residents regularly.
To continue see 9099-C1...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20211208162157

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: VILLAGE AT HERITAGE PARK, THE	FACILITY NUMBER: 342700202
	VISIT DATE: 04/22/2022

NARRATIVE

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During the investigation, LPA reviewed documentation including, but not limited to, Medication Administration Record (MAR) for Dec 2021 staffing schedule for January 2022 and pests control agency invoices. LPA conducted interviews with staff and residents. LPA interviewed Administrator, (7) staff, (5) residents, a family member of resident (R1) and attempted to interview (1) additional residents were not available for an interview.

The results of the investigation are as follows:
Facility has pests:
As soon as it was reported to the facility staff a pest control company came out within a couple of hours to check the building. The pest control company did not find any signs of mice or droppings during their checks but set out traps anyway. No mice were caught in the traps; however, the facility is located across the street from a large open undeveloped field. and pest will travel for food. LPA reviewed invoices of service every month since November 2021 to current. Based on interviews and review of service record invoices, the Department finds that the allegation that facility has Pests, is UNSUBSTANTIATED, meaning, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur,

Facility staff does not assist residents with bathing and grooming:
One resident interviewed stated that many times the residents will refuse, however, staff try very hard to get the showers in twice per week as scheduled. Two additional residents stated there have not been any problems with receiving showers. A caregiver staff stated if they are short staffed, they will ask the resident if they can give the shower the next day. Another staff stated that “showers and grooming are not skipped, generally, and caregivers have to report if showers are missed”. Administrator stated “Caregivers should note if a resident refuses the shower and grooming or if it is missed, it will be given the following morning. Staff are diligent about ensuring showers and grooming are given twice weekly, as scheduled.” Based on interviews with staff and residents, the department finds the allegation that facility staff does not assist residents with bathing and grooming is UNSUBSTANTIATED, meaning, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur,
To continue see 9099-C2...

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 25-AS-20211208162157

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: VILLAGE AT HERITAGE PARK, THE	FACILITY NUMBER: 342700202
	VISIT DATE: 04/22/2022

NARRATIVE

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Facility staff does not assist residents with incontinence needs:
It is alleged that the residents are not having their diapers changed regularly, resulting in residents having skin breakdown. Every Staff interviewed denied the allegations and stated that all of the Residents have their incontinence needs met. If they are not, having their needs met, it is due to refusal of care, which occurs in Memory Care. The Executive Director stated, “No staff can force a resident to be treated for care and that residents have the right to refuse care or treatment.” LPA observed gloves and wipes in the rooms of those who need incontinence care. The LPA checked files and determined that no residents are being treated for skin breakdown. The Residents that were interviewed, are unable to provide any information due to advanced Dementia. Based on interviews and review of medical files, the allegation that Facility staff does not assist residents with incontinence needs is UNSUBSTANTIATED, meaning, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur,

Staff do not reposition residents regularly:
LPA interviewed residents and staff. Resident interviewed stated, “Most of the time it is not comfortable in the position staff moved you to, therefore, I will move back once the staff leaves the room.” A staff that was interviewed said all residents that need repositioning are moved every two hours and some may refuse to be moved. Staff will try and encourage them, but there are some residents that are stubborn and don’t want to be moved.” The executive Director was interviewed on the topic and stated, “Staff do reposition residents. The residents that don’t want to be moved, will roll back into the position that makes them comfortable.” Based on interviews conducted files reviewed and LPA’s observation, the allegation that staff do not reposition residents regularly is UNSUBSTANTIATED, meaning, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur,

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC9099 (FAS) - (06/04)

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