342700707-6-20-2023-59-AS-MSEY-CSZV8B-20230621161224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700707
Report Date: 06/20/2023
Date Signed: 06/20/2023 05:04:16 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
03/28/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230328171724

FACILITY NAME:	ELDERLY INN III, THE		FACILITY NUMBER:	342700707
ADMINISTRATOR:	BARAC, MARINELA		FACILITY TYPE:	740
ADDRESS:	8361 CANYON OAK DRIVE		TELEPHONE:	(916) 224-8880
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 4	DATE:	06/20/2023
		UNANNOUNCED	TIME BEGAN:	02:55 PM
MET WITH:	Marinela "Mary" Barac, Administrator		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

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Residents are chemically restrained with medication
Facility staff not fingerprint-cleared
Staff are using drugs while on duty
Facility staff are abusing residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to complete the complaint investigation and deliver findings. LP met with Marinela Barac, Administrator, and explained purpose of inspection. LPA observed (2) staff, Juliet Wilson and Kassandra Howell, also present. LPA observed (4) residents in the common area and was informed (1) resident, who was under hospice care, passed earlier today.

During the investigation, LPA interviewed the Administrator, (3) staff and (3) residents and confirmed photo ID's for (3) staff. LPA reviewed staffing schedules and compared medication orders to medications being administered for (2) residents. The results of the investigation are as follows:

Allegation: Residents are chemically restrained with medication. Complaint alleges that staff are giving residents medication to keep them sleeping.

Interviews with staff indicated that the Administrator prepares the medications for residents and residents are only given medications for which there is a prescribed physician's order. Staff stated that some
cont on 9099C-1...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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 59-AS-20230328171724

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ELDERLY INN III, THE	FACILITY NUMBER: 342700707
	VISIT DATE: 06/20/2023

NARRATIVE

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9099C(1)... residents take a nap or two during the day and no residents are being "drugged" to keep them asleep. Administrator stated that she prepares the medications and she or staff will administer them and residents are only given medications that have a prescribed order. Medications were reviewed for (2) residents on 5/16/23, and it was determined that all medications are being administered as ordered and no medications are being given that do not have an order. Administrator stated that no resident is being given medication to make then fall asleep and no residents currently take cough syrup.

Three (3) residents were interviewed. One resident stated there are no issues and he receives the same medications every day at the same time. A second resident stated there have not been any problems in receiving her medications, and a third resident confirmed staff bring her medications in a little cup in the morning and evening, at the same time. Al residents interviewed stated that there are no residents sleeping all the time and residents eat meals together throughout the day.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Allegation: Facility staff not fingerprint cleared. Complaint alleges that some staff are undocumented and are not finger-print cleared. LPA reviewed staffing records and schedules and confirmed that all staff are finger-print cleared and associated to the facility. In addition, LPA confirmed all staff's identity from a photo ID or passport.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Allegation: Staff are using drugs while on duty. Complaint alleges that staff are using drugs while on duty.
All staff interviewed stated no staff have ever been observed to be under the influence of drugs or alcohol and provide good care to residents. Three (3) residents interviewed stated that staff provide excellent care. One resident stated "yes, staff helps me- the girls are awake and alert- this is a good facility". Another resident stated "They give good care here" and a third resident stated "they give very good care".
cont on 9099C-2...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20230328171724

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ELDERLY INN III, THE	FACILITY NUMBER: 342700707
	VISIT DATE: 06/20/2023

NARRATIVE

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9099C-2... Administrator stated that she has never observed staff to be under the influence of any drug or alcohol. LPA observed staff to be appear alert, awake and attending to the residents on 6/20/23 and during prior inspections on 4/4/23 and on 5/16/23.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Allegation: Facility staff are abusing residents. Complaint alleges that staff are abusing residents with no specific details provided.

All staff stated that no staff has ever been observed to abuse any resident and that all staff are doing a great job in providing care and supervision to residents. One resident stated "no staff are yelling or hitting, to my knowledge". A second resident stated he has not observed any abuse and "the caregivers are good". A third resident stated she has never observed any staff to hit or slap any resident(s), stating "they give very good care". Administrator stated that there is absolutely no abuse of any kind at the facility.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

All allegations were determined to be unfounded. There are no deficiencies cited and the complaint is being dismissed.

A Technical Advisory Note is being issued due to no order for A20 Cranberry 25,000 mcg on file with the bottle for resident (R1). Administrator confirmed that resident was never administered this medication as it was not needed and has since followed up with the physician.

Exit interview. Copy of report provided to Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

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