<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700208
Report Date: 07/18/2024
Date Signed: 07/18/2024 04:00:18 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
04/02/2024 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 59-AS-20240402094334
FACILITY NAME:AMORUSO CARE HOMEFACILITY NUMBER:
342700208
ADMINISTRATOR:CHIRA, TITIANAFACILITY TYPE:
740
ADDRESS:8967 AMORUSO AVENUETELEPHONE:
(916) 475-7261
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 3DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Daniela Barbarosie, House ManagerTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are mismanaging residents’ medications
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Daniela Barbarosie, to deliver findings into the complaint allegation listed above.

During the investigation, LPA conducted interviews, conducted a medication count, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

** Report continued on 9099-C **
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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-20240402094334
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: AMORUSO CARE HOME
FACILITY NUMBER: 342700208
VISIT DATE: 07/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Interview with relevant party indicated that "too many people" handle residents' medications and they feel that medications are not being given as prescribed.

During a visit conducted on 4/10/2024, LPA conducted a medication count for residents R1 and R2, comparing the residents’ Centrally Stored Medication Form with medications centrally stored for the residents. One medication for R2 did not have a start date documented and could not be counted to audit for medication errors. All other medications counted for R1 and R2 were off count and over the amount documented.

Based on a medication count, observation, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page.

Exit interview was conducted with House Manager. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20240402094334
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: AMORUSO CARE HOME
FACILITY NUMBER: 342700208
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2024
Section Cited
CCR
87465(a)(4)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) 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:
1
2
3
4
5
6
7
Facility will complete a statement of understanding regarding regulation 87465 and submit statement to LPA by POC due date of 7/19/2024.
8
9
10
11
12
13
14
Based on medication count and records reviewed, the facility did not ensure that residents R1 and R2 were receiving medications as prescribed, which poses an immediate health, safety, and personal rights risk 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: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 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, 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
04/02/2024 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 59-AS-20240402094334

FACILITY NAME:AMORUSO CARE HOMEFACILITY NUMBER:
342700208
ADMINISTRATOR:CHIRA, TITIANAFACILITY TYPE:
740
ADDRESS:8967 AMORUSO AVENUETELEPHONE:
(916) 475-7261
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 3DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Daniela Barbarosie, House ManagerTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not seeking timely medical attention for resident

Staff yell at residents

Staff are not treating residents with dignity

Staff are not providing incontinence care to residents in need
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Daniela Barbarosie, to deliver findings into the complaint allegations listed above.

During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

** Report continued on 9099-C **
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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 5
Control Number 59-AS-20240402094334
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: AMORUSO CARE HOME
FACILITY NUMBER: 342700208
VISIT DATE: 07/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Interview with relevant party indicated that resident (R1) has a severe bladder infection and home health services isn't coming to the facility to provide assistance. Interview with R1 conducted on 4/10/2024 indicated that R1's Home Health services were taking care of their bladder infection. R1 indicated that they had completed tests for an infection and received antibiotics, but R1 stated that antibiotics were not working. Interview with R1's Home Health Worker (HHW) indicated that R1 receives home health services once a week. HHW stated that R1 will complain about a bladder infection and initially refuse services from home health, but will accept services after advised that R1 would need to be transferred to the hospital.

LPA obtained home health records for R1. A review of home health records show that home health services were providing incontinence care and conducting regular checks for urinary tract infections (UTIs) and other infections related to incontinence for R1. During multiple visits conducted by home health, home health documented that R1 reported signs or symptoms of an infection and home health conducted an assessment and did not observe any signs or symptoms of an infection. On 2/07/2024, home health documented that R1 believed they had a UTI but home health did not observe any symptoms for a UTI and reported that R1 had received treatment for an unrelated infection. On 4/02/2024, home health documented that R1 reported not receiving treatment for a "terrible urinary tract infection" but indicated that R1 stated receiving "a strong antibiotic" to address symptoms. On 4/15/2024, home health documented that R1 had been receiving treatment for an infection starting 4/1/2024, with changes in treatment made on 4/6/2024. Based on interviews and records obtained, LPA observed R1 receiving regular observation and treatment for infections diagnosed.

Relevant party reported that facility staff yell at residents, are not treating residents with dignity, and are not providing incontinence care to residents in need. Interviews with staff member (S1), R1's HHW, resident (R3), and resident R5's responsible party indicated that they have never witnessed facility staff yelling at residents, not treating residents with dignity, and not providing incontinence care to residents in need. Interview with resident (R2) indicated that they are treated well by facility staff and satisfied with the care being provided by the facility.

Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation 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 was conducted with House Manager. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5