342700692-11-9-2020-27-AS-KHOS-BVVRNB-20201201121003

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700692
Report Date: 11/09/2020
Date Signed: 11/09/2020 03:14:00 PM

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
08/18/2020 and conducted by Evaluator Bethany Huusfeldt

COMPLAINT CONTROL NUMBER: 27-AS-20200818093029

FACILITY NAME:	A LOVING AND JOYFUL HOME RCFE		FACILITY NUMBER:	342700692
ADMINISTRATOR:	HEYDON, ANITA		FACILITY TYPE:	740
ADDRESS:	7800 CLAYPOOL WAY		TELEPHONE:	(916) 200-8447
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 4	DATE:	11/09/2020
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Anita Heydon, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not supervise resident resulting in resident eloping from facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Huusfeldt spoke with Administrator Anita Heydon over the phone due to covid precautions. LPA called administrator to deliver complaint findings.

LPA investigated the allegation of Staff did not supervise resident resulting in resident eloping from facility. LPA interviewed staff and R1 and conducted a file review of resident documents. R1 planned a visit to the DMV and rode the city bus with the knowledge of the administrator. During R1’s way to DMV and during the bus switch, R1 got lost and was found in her wheelchair and taken to the hospital. R1 was released back to the facility with no change of condition. LPA reviewed R1 LIC602 and it states resident is unable to leave the facility unassisted.

Continuation on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020

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-20200818093029

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: A LOVING AND JOYFUL HOME RCFE	FACILITY NUMBER: 342700692
	VISIT DATE: 11/09/2020

NARRATIVE

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Due to the information gathered, R1 planned a trip and administrator was aware however no one accompanied R1 and left R1 unassisted. LPA finds allegation to be SUBSTANTIATED. - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met: Refer to the 9099-D.

Exit interview conducted and appeal rights given. Exit Interview conducted. LPA will email report to licensee/administrator for review and signature. Licensee agrees to return a signed copy to LPA.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20200818093029

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: A LOVING AND JOYFUL HOME RCFE	FACILITY NUMBER: 342700692
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/09/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/12/2020 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411(a) Personnel Requirements - General -(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.	1 2 3 4 5 6 7	Administrator to send into CCL a plan of how she will complete a pre-admission appraisal and review all documentation. Plan to be sent into CCL by 11/12/20.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on record review and interviews, the licensee did not provide assistance to R1 outside of the facility which poses 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: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020

LIC9099 (FAS) - (06/04)

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