342700471-4-17-2021-27-AS-KHOS-C2QM7J-20210505092136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700471
Report Date: 04/17/2021
Date Signed: 04/17/2021 01:45:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/07/2020 and conducted by Evaluator Michael Reber

COMPLAINT CONTROL NUMBER: 27-AS-20201007144436

FACILITY NAME:	COGIR OF STOCK RANCH		FACILITY NUMBER:	342700471
ADMINISTRATOR:	DAORO-LEHNER, TRACY		FACILITY TYPE:	740
ADDRESS:	7418 STOCK RANCH RD		TELEPHONE:	(916) 725-7418
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	99	CENSUS: 89	DATE:	04/17/2021
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Toyin Spencer, Activity Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Diabetic diets not provided and prescribed

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Analyst Mike Reber arrived at the facility today, 4/17/21, and met with Activity Director, Toyin Spencer, to deliver investigation findings into the allegation that diabetic diets are not provided. During the course of the investigation, this analyst conducted interviews and obtained/reviewed documentation pertinent to the investigation.

Upon entering the facility, analyst spoke with staff to pre-screen that the facility is COVID free. Analyst also self-screened for having no known symptoms or exposure. Analyst followed facility's screening, wore an N-95 respirator and maintained distance during the visit.

**********************************Report continued on LIC 9099C********************************

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alycia Berryman	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Michael Reber	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2021

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 4

Control Number 27-AS-20201007144436

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: COGIR OF STOCK RANCH	FACILITY NUMBER: 342700471
	VISIT DATE: 04/17/2021

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

This analyst reviewed a three-month sample menu supplied by the facility. The facility hires Crandall Corporated Dieticians to create the facility menu and it is designed to meet the dietary needs of residents with special dietary restrictions. The daily menu offers low-carb options and sugar-free dessert and beverage options. In addition to the daily menu, the facility also offers an "Always Available" menu that also includes other options for diabetics such as omelets, grilled chicken and baked fish. In addition, there is a salad bar option available at meals. Analyst interviewed four kitchen staff who state that there is a board in the kitchen and a binder with resident pictures and dietary restrictions to know what food to serve to each resident. Analyst also interviewed two other diabetic residents who stated that there were no issues in receiving meals that did not meet their dietary restrictions.

Based on information obtained, Analyst finds the allegations to be UNFOUNDED – a finding meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

As a result of this investigation, no deficiencies were cited, per Title 22 Regulations, Division 6. Exit interview conducted. Copy of report left with Activity Director

Signature obtained on hard copy of report and placed in facility file.

SUPERVISOR'S NAME: Alycia Berryman	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Michael Reber	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/07/2020 and conducted by Evaluator Michael Reber

COMPLAINT CONTROL NUMBER: 27-AS-20201007144436

FACILITY NAME:	COGIR OF STOCK RANCH		FACILITY NUMBER:	342700471
ADMINISTRATOR:	DAORO-LEHNER, TRACY		FACILITY TYPE:	740
ADDRESS:	7418 STOCK RANCH RD		TELEPHONE:	(916) 725-7418
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	99	CENSUS: 89	DATE:	04/17/2021
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Toyin Spencer, Activity Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

- Resident experienced delay in physical assistance.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Analyst Mike Reber arrived at the facility today, 4/17/21, and met with Activity Director, Toyin Spencer, to deliver investigation findings into the allegation that a resident experienced delay in physical assistance. During the course of the investigation, this analyst conducted interviews and obtained/reviewed documentation pertinent to the investigation.

Upon entering the facility, analyst spoke with staff to pre-screen that the facility is COVID free. Analyst also self-screened for having no known symptoms or exposure. Analyst followed facility's screening, wore an N-95 respirator and maintained distance during the visit.

**********************************Report continued on LIC 9099C********************************

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alycia Berryman	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Michael Reber	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 27-AS-20201007144436

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: COGIR OF STOCK RANCH	FACILITY NUMBER: 342700471
	VISIT DATE: 04/17/2021

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

The complaint reports states that on 10/4/20 at approximately 5am R1 slipped from a recliner chair and "scooted" across to the bathroom to press the emergency call button. The report states that R1 waited until 7am for a first responder lift assist. Emergency call logs provided by the facility indicate that the call button was pushed at 6:33:36 am and staff responded to the resident at 6:41:13am. Per facility Fall Response Procedures, after assessing the resident a Med Tech may allow the resident to be assisted up to a chair if, the resident is able to bear weight. If resident is unable to bear weight, then then protocol is to call 911.

Interviews with two caregivers and two med techs unfamiliar with the incident confirmed that R1 is unable to bear weight and in that incident 911 would be called in the event that R1 would fall. During a visit to the facility on 3/26/21, the facility was unable to provide any documentation of the series of events that occurred the night R1 fell. There is also no documentation when emergency responders arrived at the facility or an incident report that the event occurred.

Based on the information obtained, there is insufficient evidence to determine how long R1 was on the floor or what staff did after discovering R1 on the floor.

Analyst finds the allegation to be UNSUBSTANTIATED - a finding meaning 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.

As a result of this investigation, no deficiencies were cited, per Title 22 Regulations, Division 6. Exit interview conducted. Copy of report left with Activity Director

Signature obtained on hard copy of this report and placed in facility file.

SUPERVISOR'S NAME: Alycia Berryman	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Michael Reber	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4