342700237-1-12-2023-25-AS-APEZ-CN72J6-20230117162546

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700237
Report Date: 01/12/2023
Date Signed: 01/12/2023 09:42:21 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
12/20/2022 and conducted by Evaluator Sarena Keosavang

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20221220114940

FACILITY NAME:	NELLIE'S ANGELS HOME CARE		FACILITY NUMBER:	342700237
ADMINISTRATOR:	NELLIE JOHNSON		FACILITY TYPE:	740
ADDRESS:	6730 SKYLANE DRIVE		TELEPHONE:	(916) 729-7648
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	9	CENSUS: 9	DATE:	01/12/2023
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Staff- Steven Johnson		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility staff are not releasing resident's records to resident's authorized representative.

INVESTIGATION FINDINGS:

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On 01/12/2023, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to deliver final finding. LPA met with staff, Steven Johnson, and explained the purpose of the visit. LPA ensured the following Personal Protective Equipment (PPE) was worn surgical mask. LPA were screened by facility staff and washed hands prior to entering the facility.

During the course of investigation, the Department interviewed facility staff and obtained pertinent documents relevant to the complaint investigation such as Clement Law Group PC’s letter written to Nellie’s Angels Home Care requesting for copies of resident’s (R1) records, authorization for release of records signed by R1’s Power of Attorney (POA), and affidavit of custodian of records.

Continue on page LIC9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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 3

Control Number 25-AS-20221220114940

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: NELLIE'S ANGELS HOME CARE	FACILITY NUMBER: 342700237
	VISIT DATE: 01/12/2023

NARRATIVE

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The Department requested and reviewed documentation relevant to the complaint investigation provided by the facility. A written request was sent to Nellie’s Angels Home Care by Clement Law Group PC’s requesting for R1’s documentation to be provided electronically on a CD or thumb drive and mail to their office. The Department reviewed authorization for release of records signed by R1’s Power of Attorney (POA) dated on 11/14/2022. Interview statement received from Administrator indicated facility’s law firm, Knox, Lemmon & Anapolsky LLP, is currently assisting the facility with redactions. Administrator stated all documents and notes that are redacted is necessary to protect the privacy of their residents before submitting documents to Clement Law Group PC for review which was completed on 12/27/2022. Administrator stated Clement Law Group PC did not provide facility with a deadline. On 12/28/2022, Administrator provided proof of R1’s records were produced but were not sent to Clement Law Group PC. On 12/29/2022, LPA Keosavang received an email from administrator to confirm R1’s records were provided. Records were not provided in a timely manner.

Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Health and Safety Code, Title 22, Division 6, Chapter 3.2 are being cited on the attached LIC9099D.

Appeal rights provided to the facility.

An exit interview was conducted and a copy of this report will be provided to the facility via email.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20221220114940

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: NELLIE'S ANGELS HOME CARE	FACILITY NUMBER: 342700237
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/12/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/16/2023 Section Cited HSC 1569.269(a)(21)	1 2 3 4 5 6 7	1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (21) To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided, not to exceed two business days, at a cost not to exceed the community standard	1 2 3 4 5 6 7	Admininstrator agrees to review Health and Safety Code section 1569.269 and submit to Licensing a letter of understanding by POC due date, 01/16/2023.
	8 9 10 11 12 13 14	for photocopies. This requirement is not met as evidenced by: Based on records review and interviews, R1's records were provided in a timely manner. This poses a potential health, safety, and 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: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC9099 (FAS) - (06/04)

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