342700594-7-18-2024-27-AS-SRIN-D7HVGX-20240725162617

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700594
Report Date: 07/18/2024
Date Signed: 07/18/2024 03:03:51 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
04/23/2024 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20240423154715

FACILITY NAME:	WOODLAKE, THE		FACILITY NUMBER:	342700594
ADMINISTRATOR:	JESSICA SOMMER		FACILITY TYPE:	740
ADDRESS:	1445 EXPO PARKWAY		TELEPHONE:	(916) 604-3780
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95815
CAPACITY:	144	CENSUS: 94	DATE:	07/18/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Martin Nichols, General Manager		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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1. Staff do not ensure food that is served to residents is of good quality
2. Staff spoke inappropriately while in front of resident
3. Staff yell at residents in care
4. Staff do not ensure medications are dispensed as prescribed
5. Staff do not ensure diapering needs of residents are being met
6. Staff do not ensure resident call system is responded to in a timely manner
7. Staff do not ensure facility is free of mal odors

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conclude a complaint investigation of the above mentioned allegations on 7/18/24 at 8:45a. LPA met with Martin Nichols, General Manager (GM), and stated the purpose of the visit.

On 5/2/24, LPA attempted to interview resident #1 (R1-R2) and interviewed Martin Nichols, General Manager and Angel Salcedo,Chef. LPA requested and received a copy of the following: Advertising brochures, Food Menu for April 2024, Staff roster with contact information and work schedules, Incident reports regarding any medication errors for April 2024, Diet restrictions for R1-R2, Visitors log for April 2024, last service for Call system, Facility notes regarding R1-R2 for April 2024, incontinence care schedule, medication list for R1, Weight record for R2, and Resident roster.

During today’s visit, LPA continued conducting interviews of staff and residents and reviewing facility documents.

Unfounded

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

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-20240423154715

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: WOODLAKE, THE	FACILITY NUMBER: 342700594
	VISIT DATE: 07/18/2024

NARRATIVE

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Regarding allegation, “Staff do not ensure food that is served to residents is of good quality” LPA observed advertised in the facility’s marketing brochure as “on-site chef and food service team serves healthy, well-balanced meals”, “full-service dining featuring seasonal menus and healthy choices”, monthly fee includes three meals daily plus complimentary snacks”. LPA did not observe the facility to promote gourmet dining on brochures. Staff 1-8 and R3-R6 all concurred through interviews which revealed that the food is good, there is a variety of options and snacks. Based on facility records, R1 and R2 are not on a modified diet. R2 has also gained 5 lbs from January – March and lost 2 lbs in April of 2024. During unannounced visits on 5/2/14, 7/17/24, and 7/18/24, LPA observed residents eating meals that were on the menu and others having an option of their choice. During todays visit, LPA observed a resident when asked preferred to have breakfast instead of lunch during the lunch time. That request was provided.

Regarding allegation, “Staff spoke inappropriately while in front of resident” LPA obtained information through interviews of staff 1-8 and R3-R6 all concur that staff are not speaking inappropriately to residents. LPA did not obtain a preponderance of evidence regarding this allegation.

Regarding allegation, “Staff yell at residents in care” LPA obtained information through interviews of staff 1-7 and R3-R6 all concur that staff are not yelling at residents. LPA did not obtain a preponderance of evidence regarding this allegation.

Regarding allegation, “Staff do not ensure medications are dispensed as prescribed” LPA observed a fax dated 4/22/24 to R2’s doctor indicating responsible party delivered to the facility Lorazapam 0.5mg. the bottle indicated 15 tabs but when counted it contained 24 tabs. Based on records and confirmation from GM Responsible Party altered the label and added extra pills that were left over from a previous prescription. Facility contacted the physician for a new prescription for R2. The locked cabinet in each resident’s room is checked on a daily basis. Based on interviews with staff the cabinets contain hygiene products such as lotion, soap, shaving cream, toothpaste, etc. However, the interviews revealed that there are never chemicals or medications locked in residents’ room. LPA observed that R1 and R2’s locked cabinet was checked and expired chemicals and/or medications were found inside. Facility reiterated to responsible party that all medications are centrally stored with the facility and expired medications are destroyed. In addition, staff was provided a medication in-service which was conducted on 5/2/24.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20240423154715

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: WOODLAKE, THE	FACILITY NUMBER: 342700594
	VISIT DATE: 07/18/2024

NARRATIVE

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Regarding allegation, “Staff do not ensure diapering needs of residents are being met” R3-R6 all concur that staff assist with hygiene and adheres to the shower schedules. The investigation revealed through interviews of staff 1-8 and residents 3-6 and Community Care Licensing unannounced visits on 5/2/14, 7/17/24, and 7/18/24 which included a tour of facility, there is no mal odors in the facility that indicates diapers are not being changed. LPA did not obtain a preponderance of evidence regarding this allegation.

Regarding allegation, “Staff do not ensure resident call system is responded to in a timely manner” LPA conducted interviews of staff 1-8 on 5/2/14, 7/17/24, and 7/18/24. The E-call system called Ciscor in common areas and resident apartments are checked quarterly January, April, July, and October. The log showed the response time as anywhere between a few seconds to 49 minutes and 52 seconds. The interviews revealed that the response time on the Ciscor system is indicative of the time it took to assist residents with a need or emergency not that it took that length of time to arrive to assist the residents. R3-R6 all concur that the response time is sufficient. During the hiring process the facility uses a system called Relias for training. During the course of 12 months the training is re-iterated through monthly in-service training.

Regarding allegation, “Staff do not ensure facility is free of mal odors” The investigation revealed that through interviews of staff 1-8 and residents 1-6 and Community Care Licensing unannounced visits on 5/2/14, 7/17/24, and 7/18/24 which included tour of facility there is no mal odors in the facility. R3-R6 all concur that the facility is free of odors.

The allegations above are deemed Unfounded, based on a lack of preponderance of evidence..

"The allegation is UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint."

Per California Code of Regulations, no deficiencies were observed or cited.

Exit interview held, and a copy provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

LIC9099 (FAS) - (06/04)

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