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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700333
Report Date: 04/08/2021
Date Signed: 04/08/2021 04:10:24 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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
10/26/2020 and conducted by Evaluator Melana Llopis
COMPLAINT CONTROL NUMBER: 27-AS-20201026103249
FACILITY NAME:FAIR OAKS ESTATES INCFACILITY NUMBER:
342700333
ADMINISTRATOR:SAROAY, PARVEENFACILITY TYPE:
740
ADDRESS:8845 FAIR OAKS BLVDTELEPHONE:
(916) 944-2077
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:106CENSUS: 78DATE:
04/08/2021
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Executive Director, Parveen SaroayTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff did not seek medical attention for residents
Staff did not prevent the spread of scabies
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Melana Llopis contacted the facility unannounced via telephone on 04/08/2021 due to Covid 19 and precautionary measures. LPA spoke with the Executive Director, Parveen Saroay and explained the purpose of the call was to deliver findings for a complaint the Department received on 10/26/2020. ***Due to the Covid-19 pandemic the investigation for this complaint was delayed.***

Throughout the course of the investigation Community Care Licensing (CCL) conducted interviews, and reviewed documentation pertinent to the allegations listed above.

The results are as follows:

***Continuation on LIC9099-C***
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Melana LlopisTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021
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-20201026103249
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: FAIR OAKS ESTATES INC
FACILITY NUMBER: 342700333
VISIT DATE: 04/08/2021
NARRATIVE
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The complaint alleged the facility did not seek medical attention for residents with rashes and did not prevent the spread of scabies. Interviews conducted and records reviewed indicate there were two (2) residents in care who tested positive for scabies in October 2020 and five (5) additional residents who reported "itchy and redness of skin" during the months of August - October 2020.

On 03/29/2020 LPA reviewed R1 and R2’s progress notes and incident reports. Progress notes show the facility contacted R1’s Primary Care Physician (PCP) on 09/13/2020 via FAX regarding R1’s skin rash and followed up on 09/24/2020 via FAX – no response from PCP was indicated. On 10/07/2020 the facility contacted the VA to inform R1’s PCP their rash was increasing and needed a new medication order. On 10/18/2020, R1’s PCP was notified by the facility that the rash was not improving. Incident reports reveal R1 was brought to the hospital due to “not being at their baseline” and received further evaluation on 10/19/2020. On 10/20/2020 R1 had an in-person Dr.’s visit and was diagnosed with scabies. Treatment and instructions were provided.

On 09/29/2020, R2 reported symptoms of a rash. Progress notes reveal facility attempted to contact R2’s PCP regarding the rash on 09/29/2020 via FAX. Further Progress Notes show facility attempted to contact R2’s PCP for the next several days (from 09/30 – 10/20/2020) via FAX and phone but reported no response from R2’s PCP. Then on 10/20/2020, the facility notified R2’s PCP of a resident in the community who tested positive for scabies and requested preventative treatment. On 10/27/2020, R2 was prescribed a treatment cream and antibiotic by their PCP. Interview with Administrator stated R2 was diagnosed with scabies in October 2020 but no date could be confirmed and discharge paperwork was unavailable to be reviewed.

Interviews with four (4) of four (4) staff stated they were aware the facility had a positive scabies resident in the community. Majority of staff reported they were given instruction on how to treat the skin condition. Staff reported they were instructed to “isolate the resident” with scabies, wash their laundry separate, wear gloves when providing care and continuously clean and disinfect surfaces.
On 04/01/2021, LPA reviewed a sample of nine (9) of nine (9) residents’ progress notes (PN) and FAX reports sent to residents' PCPs. PN and FAX reports indicates the facility notified residents’ PCPs of a positive scabies case in the community on 10/20/2020 and requested preventative treatment for each resident.

Based on the information above, LPA finds the allegations: Staff did not seek medical attention for residents,
Staff did not prevent the spread of scabies, to be 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.

An exit interview was conducted with Executive Director via telephone and a copy of report was provided to the Administrator via email, an electronic email read receipt confirms receiving these documents. Administrator will sign 9099 and 9099-C, and send back electronic email to LPA Llopis on today's date.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Melana LlopisTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021
LIC9099 (FAS) - (06/04)
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