342700333-7-10-2020-27-AS-MSEY-BRPSWV-20200720141456

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700333
Report Date: 04/08/2020
Date Signed: 07/10/2020 10:43:28 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/06/2020 and conducted by Evaluator Melana Llopis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200306160617

FACILITY NAME:	FAIR OAKS ESTATES INC		FACILITY NUMBER:	342700333
ADMINISTRATOR:	SAROAY, PARVEEN		FACILITY TYPE:	740
ADDRESS:	8845 FAIR OAKS BLVD		TELEPHONE:	(916) 944-2077
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	106	CENSUS: 83	DATE:	04/08/2020
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Executive Director, Parveen Saroay		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff neglect resulting in residents pressure injury worsening
Staff did not provide a comfortable bed for resident

INVESTIGATION FINDINGS:

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**The complaint findings have been changed from unfounded to substantiated. See 9099 report dated 7/10/2020 for deficiency issued. **

Licensing Program Analyst Llopis contacted the facility via telephone on 04/08/2020 to provide complaint findings via telephone due to COVID-19 and pre-cautionary measures. LPA discussed the purpose of the call and the elements of the allegation with Executive Director (ED), Parveen Saroay.

Throughout the course of the investigation, the Department conducted multiple interviews with staff and key witness and reviewed documentation pertinent to the investigation.

***Continuation on 9099-C***

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: (510) 298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2020

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 27-AS-20200306160617

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: FAIR OAKS ESTATES INC	FACILITY NUMBER: 342700333
	VISIT DATE: 04/08/2020

NARRATIVE

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Allegation: Staff neglect resulting in residents pressure injury worsening

Interviews and documentation review revealed R1 moved into that facility on 01/28/2020 and was receiving Sutter Home Health upon admission. Facility staff stated R1 was receiving Home Health 2-3x a week for wounds and skin discoloration. Facility staff reported Home Health did not provide the facility with progress notes or care notes. Staff reported they were told to reposition R1 every two (2) hours, assist with bed baths, oral care, apply ointment treatment, assist with medications and clean R1's bed sheets. Six (6) of six (6) staff interviewed stated R1 was very difficult to work with and refused staff assistance with bathing, showering, repositioning, turning, rotating, oral care, ointment treatment, and medication. The facility attempted "Change of Face," however R1 still refused assistance with care. Incident reports also showed R1 was noncompliant with care. Interview with key witness stated they have never been to the facility, nor witnessed R1's care. R1 refused to be interviewed.

Allegation: Staff did not provide a comfortable bed for resident

Interviews and documentation review revealed on 01/28/2020 R1 moved into the facility with a bed ordered and provided by Sutter Hospital. R1 was later admitted to the hospital on 03/06/2020 and did not return to the facility. The facility staff reported R1's bed was picked up by Agency Provider and was unable to be reviewed. R1 refused to be interviewed. Key witness stated they never saw R1's bed.

Based on the information above, the Department finds the allegation(s) to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with ED via telephone and a copy of this report will be provided to the facility via email and United States Postal Service. Two copies will be sent to the facility, 1 is to be signed and returned to CCL and the other copy is to be retained by the facility.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: (510) 298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2020

LIC9099 (FAS) - (06/04)

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