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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700202
Report Date: 06/01/2023
Date Signed: 06/01/2023 06:00:11 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/06/2023 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20230306110530
FACILITY NAME:VILLAGE AT HERITAGE PARK, THEFACILITY NUMBER:
342700202
ADMINISTRATOR:KENT MULKEYFACILITY TYPE:
740
ADDRESS:2001 ROSE ARBOR DRIVETELEPHONE:
(916) 216-8958
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:108CENSUS: DATE:
06/01/2023
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Desiree Tawney, Business Office ManagerTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility does not respond to residents in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conclude and deliver findings to a complaint investigation. LPA met with Desiree Tawney, Business Office Manager, as the Administrator was not currently at the facility.

During the investigation, LPA interviewed the Executive Director, Memory Care Coordinator, Resident Care Coordinator and (1) staff. LPA also toured the Assisted Living and Memory Care units, including the dining room and activity areas, and obtained a copy of the pendant response times report for January, February and March 2023. LPA also reviewed pendant response times for resident (R1) for period 3/4/23- 3/5/23 and staffing schedules. The results of the investigation are as follows:

Allegation: Facility does not respond to residents in a timely manner. Complaint alleges that due to a staffing shortage on/around March 6, 2023, Facility does not respond to residents in a timely manner- waits can be 1-2 hours. The results of the investigation are as follows:
cont on 9099C-1..
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
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 5
Control Number 59-AS-20230306110530
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: VILLAGE AT HERITAGE PARK, THE
FACILITY NUMBER: 342700202
VISIT DATE: 06/01/2023
NARRATIVE
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90999C-1..Administrator stated on 3/8/23 that staff respond to resident call buttons timely with an average response time between 7-10 minutes and the reports are reviewed occasionally. The Administrator confirmed current Assisted Living Unit (ALU) staffing levels as: 4 caregiver, 1 Med-Tech and 1 Resident Care Coordinator for a total of 6 staff during the day shifts, stating he feels the facility has adequate coverage at this time. Administrator stated "we had a lot of staff out sick but we have managers that filled in".
Staffing schedules were reviewed for January, February and March 2023 for Assisted Living Unit and Memory Care Unit. Staffing schedules for Assisted Living show staffing varied from 3-6 caregivers during the "am" shift, averaged 3 caregivers on the "pm" shift and averaged 2 caregivers on the "NOC" shift. In addition, there is always (1) nurse and/or Med-Tech on duty.

LPA reviewed pendant response times for (2) specific days in March 2023 for resident (R1). Records show R1 pressed her pendant a total of (17) times with response times varying from approximately (1) minute to 1 hour, 23 minutes. There were (9) responses of (15) minutes or less; (6) responses between (21-29) minutes and (2) responses of (1) hour (20-23) minutes on 3/4/23 at 11:52 am and 11:54 am.

Report provided for March 2023 response times for all residents is 431 pages. Records show resident (R2) pushed the pendant (4) times on 3/2/23 between approximately 6:45 pm- 7:00 pm and response times varied between (42) and (55) minutes. LPA observed on 3/4/23 there were multiple response times of over (30) minutes also for multiple residents.

Based on information obtained, LPA finds the allegation to be SUBSTANTIATED- meaning the preponderance of evidence standards has been met.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiency is issued on the 9099-D page.

Exit interview. Copy of report and appeal rights provided to Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/06/2023 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20230306110530

FACILITY NAME:VILLAGE AT HERITAGE PARK, THEFACILITY NUMBER:
342700202
ADMINISTRATOR:KENT MULKEYFACILITY TYPE:
740
ADDRESS:2001 ROSE ARBOR DRIVETELEPHONE:
(916) 216-8958
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:108CENSUS: DATE:
06/01/2023
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Desiree Tawney, Business Office ManagerTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are not providing adequate food service to residents.
Facility does not have adequate PPEs and/or COVID-19 supplies.
INVESTIGATION FINDINGS:
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During the investigation, LPA interviewed the Executive Director, Memory Care Coordinator and Resident Care Coordinator. LPA also toured the Assisted Living and Memory Care units, including the dining room and activity areas, and obtained a copy of the pendant response times report for January, February and March 2023. LPA also reviewed pendant response times for resident (R1) for period 3/4/23- 3/5/23. LPA also observed current PPE supply.

The results of the investigation are as follows:

Allegation: Staff are not providing adequate food service to residents. Complaint alleges that due to the COVID-19 cases, residents are to stay in their room and meals will be delivered to resident's rooms by staff.and there was one recent incident where no meal was delivered to her R1's room from 4-7PM

cont on 9099AC-1..
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 59-AS-20230306110530
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: VILLAGE AT HERITAGE PARK, THE
FACILITY NUMBER: 342700202
VISIT DATE: 06/01/2023
NARRATIVE
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9099AC-1.. Admin stated on 3/8/23 the ALU dining room remains open for residents who have tested negative- they have the choice to dine there or take the food to go. All positive residents are served meals in their rooms. LPA toured the facility on 3/8/23 and observed the Assisted Living Dining room to be closed and observed (2) residents from Independent Living dining there. LPA observed staff delivering meals to Assisted Living residents who were quarantining or isolating on 3/8/23. Pendant response time were reviewed for resident (R1) on 3//4/23 and 3/5/23. Response times were under 30 minutes during the time when dinner would have been served from 4:30-6:00 pm. There is no documentation to confirm that R1's dinner wasn't served until 7:00 pm.

Based on information obtained, LPA finds this allegation to be 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.

Allegation: Facility does not have adequate PPEs and/or COVID-19 supplies.
Complaint alleges the facility currently has positive COVID-19 cases in the facility but does not have rapid antigen test available at the facility.

On 3/8/23, Memory Care Coordinator (MCC) stated the community "never ran out of Covid tests", she personally went to CVS, twice, to purchase more tests. In addition, MCC stated that 'PPE has always been available" to the community and there were additional supplies in storage. LPA observed many boxes of PPE supplies on 3/8/23 when touring the facility and took photos. Administrator confirmed the facility does have test kits and has been using rapid tests and more are being shipped to the facility, commenting "there may have been a lapse of 2 hours where we ran out of Covid tests but my staff personally went to CVS to get more". A family member of (R1) stated staff had personal masks but there were not any Covid tests- so she brought in (6) tests she had from home and it was hours later that she did so and the staff stated they then had tests. Resident Care Coordinator (RCC) stated on 3/8/23 she was out of the community when the Covid cases started last week. confirmed the first case happened on 2/27/23 or on 2/28/23 and it was for a resident who lives in ALU, and staff immediately began using PPE.

Based on information obtained, LPA finds this allegation to be 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.
Exit interview. Copy of report left at facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20230306110530
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: VILLAGE AT HERITAGE PARK, THE
FACILITY NUMBER: 342700202
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/15/2023
Section Cited
CCR
87411(a)
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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:
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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 every hall, if a caregiver is busy with another resident or on break, so the call be answered timely.
Administrator to review the pedant response reports at least weekly to ensure they are being answered timely.
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Based on record review, the Licensee did not ensure that staff responded timely to resident's (R1) request for assistance when the call button was used on 3/4/23 at 11:52 am and for resident (R2) on 3/3/23 at 7:35 am. Response time was 1 hour 23 minutes for R1 and 46 minutes for R2.
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Documentation to be submitted to CCLD by fax/email by 6/15/23.
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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 SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5