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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700722
Report Date: 11/07/2023
Date Signed: 11/07/2023 04:49:58 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
08/31/2023 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230831133807
FACILITY NAME:WELLQUEST OF ELK GROVEFACILITY NUMBER:
342700722
ADMINISTRATOR:SIMON, CASEYFACILITY TYPE:
740
ADDRESS:8871 E STOCKTON BLVDTELEPHONE:
(916) 689-1000
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:170CENSUS: 78DATE:
11/07/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Luna GarciaTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff are not following medical professional's orders.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a complaint investigation and deliver complaint findings. LPA met with Business Office Manager Luna Garcia, and explained the purpose of the visit. The investigation consisted of staff interviews, facility records review, medical record review, and interviews with an outside party.

According to information shared with LPA, R1 was left outside during the summer of 2022. When R1's family visited R1, the family observed R1 to have sun burn all over R1's face. Based on shared information, R1 was taken to the urgent care for treatment.

LPA reviewed medical records. R1 was seen at a local hospital on 05/09/2022 for a Office Visit to conduct a skin check due to sun exposure. Medical records show a sun screen order was provided to the facility.
Continues on LIC 9099 - C...

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
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 7
Control Number 27-AS-20230831133807
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: WELLQUEST OF ELK GROVE
FACILITY NUMBER: 342700722
VISIT DATE: 11/07/2023
NARRATIVE
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Continues from LIC 9099
Based on review of the facility records obtained by LPA on 09/01/2023, there was an order dated and signed on 05/09/2022 by a physician for the following: Neutrogena Invisible daily lotion - apply as directed on tube to the face, ears, neck as needed - SPF 60+, Neutrogena ultra sheer SPY 70 - apply as directed on bottle as needed to the arm and legs. According to Medication Administrator Records (MAR) for May of 2022, LPA observed sunscreen being provided on 05/16/22, 05/18/22, 05/23/22, 05/24/22, 05/25/22, 05/30/22, and 05/31/222. The dates that it was provided was provided by the same staff member each time. LPA observed a trend where primarily the same staff member was the individual to assist with the PRN. During October 2022, November 2022, December 2022, January 2023, February 2023, March 2023, the PRN for specific cream was not provided for R1. On 04/04/23, R1's treating physician wrote a letter and provided orders to update the sunscreen from a PRN to a daily prescribed cream. According to MAR records for April 2023, the PRN orders did not change. MAR records reviewed for May 2023 show that the facility started an order effective 04/04/2023 for "Sunscreen lotion and spray and hat - not given by facility". There were no signatures noted for this order; however, there are signatures for the previous PRN orders. On 05/09/23, another physician submitted an signed order to the facility. "Dear Care Team: Please apply the below sunblock lotion... before spending time outside. Banana Board Kids Sport 50 Powerstay Technology Tear and Sting Free. Based on review of the MAR for May 2023, the facility inputted it as a PRN. This was discontinued in October of 2023.

Facility Records and Medical Records show that Topical creams Calcipotriene and Flurorouracil was ordered to start on 09/22/22, however, cream was not applied until 09/26/22 during PM shift due to not receiving the creams and "daughter requesting the start of cream on 09/27/22 due to doctor wanting the family member to teach medication technicians on how to apply the cream."

According to a staff interview, the facility does not create the MARs. The MARs are created by Yorba Linda Pharmacy, an outside agency.

Based on medical record review, interview, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided. An exit interview was conducted, and a copy of the report was provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
08/31/2023 and conducted by Evaluator Christina Valerio
COMPLAINT CONTROL NUMBER: 27-AS-20230831133807

FACILITY NAME:WELLQUEST OF ELK GROVEFACILITY NUMBER:
342700722
ADMINISTRATOR:SIMON, CASEYFACILITY TYPE:
740
ADDRESS:8871 E STOCKTON BLVDTELEPHONE:
(916) 689-1000
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:170CENSUS: DATE:
11/07/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Luna GarciaTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Resident sustained severe burn.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a complaint investigation and deliver complaint findings. LPA met with Business Office Manager Luna Garcia, and explained the purpose of the visit. The investigation consisted of staff interviews, facility records review, medical record review, and interviews with an outside party.

According to information shared with LPA, R1 was left outside during the summer of 2022. When R1's family visited R1, the family observed R1 to have sun burn all over R1's face. LPA Valerio received pictures from 2022 regarding Resident 1 (R1). In a picture dated March 2022, LPA observed R1 sitting outside in the courtyard area. R1 was observed sitting in a chair with a shirt and shorts with eyes closed while in the sun. Pictures dated October 2022, R1's face is observed in the picture with angles of the left and right side of the face. There are red blotches on R1's face and dark brown discolored skin that is peeling off.

Continues on LIC 9099 - C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
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 7
Control Number 27-AS-20230831133807
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: WELLQUEST OF ELK GROVE
FACILITY NUMBER: 342700722
VISIT DATE: 11/07/2023
NARRATIVE
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Continues from LIC 9099 - A
The pictures show that R1's face is red on the sides of R1's temples down to R1's entire cheek and across R1's nose.

According to Medical Records, R1 was seen by a Physician on 05/09/2022 at due to excess exposure to the sun and left with an order for the "nursing home to apply sunscreen." According to Medical Records, R1 was seen by a Physician for a skin check. Records indicate that R1 was diagnosed with Actinic Keratosis. LPA searched Actinic Keratosis on google. According to Mayo Clinic Web Search, Actinic Keratosis is a rough, scaly patch on skin, hard, wartlike surface, with a skin appearance of color variation, including pink, red or brown caused by frequent or intense exposure to ultraviolet rays from the sun or tanning beds (Mayo Foundation for Medical Education and Research, 2023). On 09/22/22, R1 was treated for sun damaged skin. Medical Records show that the R1 was seen by the same physician in April of 2023, May of 2023, and October of 2023.

LPA attempted to interview 6 staff members (S1 - S6). 1 staff member denied answering questions, 2 were unavailable, and 4 were deemed successful. S3 stated that all staff have the responsibility to check on the residents who chose to sit outside. Residents have the right to sit outside if they chose; however, staff are to assist with needs, such as offering water, redirecting to shade, or prompting. Staff stated that if a resident does not listen or oblige to prompt, staff cannot force the resident to do anything. S3 stated they always put sunscreen on R1 since last summer but could not speak to any other staff. S5 stated if there was ever a resident sitting outside for too long, S5 would make sure to take the resident out from the sun. S5 does not recall any resident's sitting outside for a long period of time.

Based on file review of facility records, there is no record of R1 being observed sitting outside for an extended period of time without staff intervention.

Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. An exit interview was held, and a copy of report was provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 7
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
08/31/2023 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230831133807

FACILITY NAME:WELLQUEST OF ELK GROVEFACILITY NUMBER:
342700722
ADMINISTRATOR:SIMON, CASEYFACILITY TYPE:
740
ADDRESS:8871 E STOCKTON BLVDTELEPHONE:
(916) 689-1000
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:170CENSUS: DATE:
11/07/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Luna GarciaTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility did not ensure staff are trained to meet resident’s needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a complaint investigation and deliver complaint findings. LPA met with Business Office Manager Luna Garcia, and explained the purpose of the visit. The investigation consisted of staff interviews, facility records review, medical record review, and interviews with an outside party.

According to shared information, a staff member (S4) was reported to tell a family member that they were never informed on the care plan for Resident 1 (R1). LPA attempted to interview 7 staff; however, only 3 were successful. LPA Valerio attempted to interview the staff member (S4); however, the interview was deemed unsuccessful and could not be completed. LPA attempted to interview another staff member that provided direct oversight; however S1 denied participating in the interview. S2 and S3 stated training and updates are provided for any new orders that come in for residents during shift change and the bulletin board.
Continues on LIC 9099- C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 27-AS-20230831133807
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: WELLQUEST OF ELK GROVE
FACILITY NUMBER: 342700722
VISIT DATE: 11/07/2023
NARRATIVE
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Continued from LIC 9099 - A

According to S5, the facility has training but feels that the current staff need extra training on how to care for residents on the memory care side. S5 stated they are unaware if anyone at the facility has an order for sunscreen. According to Staff 7 (S7), the facility has all employees to go through an orientation checklist. Each individual will go through 9 hours of online topics, Relias General Topics, 2 days of shadow training, along with a supervised medication pass, CPR refresher, and review with working with Pharmacy, Med Room and EHR protocols. Additional training is provided by the Health and Wellness Director and the Resident Care Coordinator.

LPA reviewed facility training files. LPA observed 6 staff files to have 20-40 hours of completed training prior to being left alone on the floor. Based on records review, the facility has copies of additional in-service training provided by management staff.

Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. An exit interview was held, and a copy of report was provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 27-AS-20230831133807
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: WELLQUEST OF ELK GROVE
FACILITY NUMBER: 342700722
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/08/2023
Section Cited
CCR
87465(c)(2)
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87465 Incidental Medical and Dental Care c).. provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by:

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Licensee will send a statement explaining the facility's plan to ensure all resident orders will be followed. LPA to receive statement by POC due date of 11/08/2023.
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Based on records review, the licensee did not ensure R1's physician orders were followed. This poses an immediate health, safety, or personal rights risk to residents in care.
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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: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7