342700579-6-21-2023-27-AS-KHOS-CU5MU8-20230727095443

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700579
Report Date: 06/21/2023
Date Signed: 06/21/2023 12:20:19 PM

Substantiated

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
06/20/2023 and conducted by Evaluator Tung Truong

COMPLAINT CONTROL NUMBER: 27-AS-20230620105201

FACILITY NAME:	CHATEAU AT RIVER'S EDGE, THE		FACILITY NUMBER:	342700579
ADMINISTRATOR:	MICHAEL TALANI		FACILITY TYPE:	740
ADDRESS:	641 FEATURE DR		TELEPHONE:	(916) 921-1970
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	143	CENSUS: 74	DATE:	06/21/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Elena Cuevas		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff administered the wrong medication to resident

INVESTIGATION FINDINGS:

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On 6/21/23, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit at this facility to commence a complaint investigation with the allegations above. LPA met with Interim Administrator Elena Cuevas and explained the purpose of the visit.

Based on records reviewed and interviews, it was determined that the facility did not administer the correct medication to resident (R1). Facility Interim Administrator corroborated that another resident's medications were being given to R1. The Med Tech (S1) admitted to have made this med error.

Continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

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 27-AS-20230620105201

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: CHATEAU AT RIVER'S EDGE, THE	FACILITY NUMBER: 342700579
	VISIT DATE: 06/21/2023

NARRATIVE

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Based on interviews conducted, and records reviewed, the preponderance of evidence standards has been met, therefore, the above allegation(s) is/are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 9099D during this visit.

Exit interview was conducted, a copy of the report, LIC 9099-D and appeal rights were provided.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20230620105201

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: CHATEAU AT RIVER'S EDGE, THE	FACILITY NUMBER: 342700579
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/21/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/22/2023 Section Cited CCR 87465(a)(5)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility... compliance with the following: (5) The licensee shall assist residents with. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The facility will have an outside agency conduct a training on medication administration, medication storage, medication ordering and medication verification for med-techs. Administrator will email LPA a training agenda and the agency conducting the training by 6/22/2023.
	8 9 10 11 12 13 14	Based on interviews and records review, the licensee did not ensure R1 was being administered medication as prescribed. Another resident's medications were given to R1 by staff. This posed an immediate health and safety risk 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: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

LIC9099 (FAS) - (06/04)

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