342700237-7-12-2023-59-AS-APEZ-CTPLFP-20230713084329

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700237
Report Date: 07/12/2023
Date Signed: 07/12/2023 12:38:35 PM

Unfounded

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
03/28/2023 and conducted by Evaluator Sarena Keosavang

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230328162656

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: 7	DATE:	07/12/2023
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Administrator: Stephanie Reid		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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- Residents are chemically restrained with medication.
- Facility staff not fingerprint-cleared.
- Staff are using drugs while on duty.
- Facility staff are abusing residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 07/12/2023 to deliver complaint findings. LPA met with Administrator, Stephanie Reid, and explained the purpose of the visit.

During the course of investigation, the Department interviewed facility staff, residents in care, and obtained pertinent documents relevant to the complaint investigation such as, nine (9) residents’ (R1, R2, R3, R4, R5, R6, R7, R8, & R9) physician’s report, identification and emergency information, medication list, physician’s orders, medication administration records (MAR), employee roster, and resident roster.

Continue on page LIC 9099-C.

Unfounded

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: 07/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

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 59-AS-20230328162656

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: NELLIE'S ANGELS HOME CARE	FACILITY NUMBER: 342700237
	VISIT DATE: 07/12/2023

NARRATIVE

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Allegation: Residents are chemically restrained with medication. Unfounded.
LPA reviewed 9 of 9 resident medications, comparing with physician orders. Administrator stated all medications are dispensed as ordered by the physician and medications are never given to chemically restrain residents. LPA interviewed one (1) facility staff. S1 indicated the designated person to assist resident with medication is the administrator. LPA interviewed one (1) resident (R1) that were able to be interviewed. R1 reported R1 are given their prescribed medications daily.

Allegation: Facility staff not fingerprint-cleared. Unfounded.
LPA reviewed staff files, training, and reviewed facility association list. LPA observed that all staff are associated to the facility roster, and have valid ID's.

Allegation: Staff are using drugs while on duty Unfounded.
LPA interviewed one (1) caregiver and conducted a facility tour. LPA did not observe any illegal drugs or evidence of drug use. LPA interviewed caregiver on shift, and caregiver stated they have not used drugs or seen other staff members use drugs while on duty. LPA interviewed administrator in which she stated she has not had any staff use drugs while on duty. LPA interview one (1) resident, and R1 stated they have not observed staff on duty using drugs.

Allegation: Facility staff are abusing residents. Unfounded.
LPA interviewed caregivers and administrator in which they stated they have not abused residents in anyway and they have not observed any other staff member abuse residents. LPA interview one (1) resident, and R1 stated they have not observed any residents in care being abused by staff.

The allegations are UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

LIC9099 (FAS) - (06/04)

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