342700821-3-4-2022-25-AS-MSEY-CCB2M4-20220307163031

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700821
Report Date: 03/04/2022
Date Signed: 03/04/2022 05:11:21 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/17/2021 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20211217151503

FACILITY NAME:	BLUEBERRY HILL SENIOR LIVING, INC.		FACILITY NUMBER:	342700821
ADMINISTRATOR:	HAMRIC, KEITH		FACILITY TYPE:	740
ADDRESS:	3827 OLIVE LANE		TELEPHONE:	(916) 900-8399
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS:	DATE:	03/04/2022
		UNANNOUNCED	TIME BEGAN:	03:50 PM
MET WITH:	Christina Pena, Caregiver		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Licensee is not following doctors orders
Staff force residents to wake up at unreasonable time in the morning
Licensee does not did not treat residents with dignity and respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint the department received on 12/17/2021. LPA's met with Christina Pena, caregiver, who contacted the Administrator, Keith Hamric, and staff, Megan Hamric, by phone. Caregiver confirmed there are (6) residents present and there are currently no residents receiving hospice services. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN95 mask.

During the course of the investigation, LPA interviewed Administrator, (4) staff, (6) residents and (2) family members and reviewed documentation including, but not limited to, various documents from resident's (R1) file, and multiple pages of staff shift notes provided for random days from 7/19/2021 to 10/24/2021.

The results of the investigation are as follows:
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: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

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 4

Control Number 25-AS-20211217151503

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BLUEBERRY HILL SENIOR LIVING, INC.	FACILITY NUMBER: 342700821
	VISIT DATE: 03/04/2022

NARRATIVE

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9099C(1).. Allegation: Licensee is not following doctors orders.

Allegation states that on/around September/October 2021, the Administrator refused to allow resident (R1) to have her prescribed Ativan medication for pain because the Administrator would have to dispense the medication to her. Allegation further states that resident was believed to be in pain due due to picking the open wounds on her chest and arms, and the wounds are not healing because resident picks at them.

Physician's orders dated 7/31/2021 note that R1 was to be discharged from hospice services and to discontinue multiple medications, including Ativan. A subsequent order was issued on 8/27/2021 to discontinue all hospice medications given at bed-time and to start Trazadone 100 mg at bedtime for insomnia.
E-mail dated 8/2/2021 from R1's health care provider to the Administrator states that R1 is "being discharged from hospice services as her prognosis has extended" and discusses how home health will be able to assess and manage the "non-healing lesions" while R1 resides at the facility.

Home Health Nurse charting notes, dated 9/23/2021 to 12/6/2021, document that wound care was being provided, R1 tolerated it well and there were no signs of infection. Notes dated 11/17/2021, indicate that the wound was "improving-doing well" and skin assessment was performed with no breakdown shown. Notes entered on 11/22/2021 document that R1 stated ""ouch" during wound care but shows no signs of being in pain".

Staff (S1) stated in an interview that Ativan is a medication for agitation and not for pain. Staff (S2) stated that her understanding is that Ativan is a comfort medication that hospice care provides even if it is not needed and that if R1 shows discomfort from the wound, staff would give PRN medications. R1 was not able to be interviewed due to a diagnosis of Alzheimer's Dementia and being non-verbal, as noted on the Resident Appraisal, dated 12/6/2020.

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

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: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20211217151503

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BLUEBERRY HILL SENIOR LIVING, INC.	FACILITY NUMBER: 342700821
	VISIT DATE: 03/04/2022

NARRATIVE

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90909C(2)..Allegation: Staff force residents to wake up at unreasonable time in the morning.

Allegation states that since around June 2021, staff have been required to wake the residents up between 5:00 am- 6:00 am so that residents are prepared for the next shift.

Staff (S5) informed LPA's Calzada and Yang that some residents are up already by the time she starts on the morning shift at 7:30 and explained that upon starting her shift, she takes vitals and temperature and then prepares breakfast for residents. S5 indicated that if residents choose to stay in bed, she will let them and reheat breakfast when residents wake up. Staff (S2) stated to to LPA's that staff does not force residents to get up in the morning at a certain time but rather staff knows each resident's routine. S2 explained that there is not a set schedule for residents to wake up at a certain time, and residents can get up when they prefer and know breakfast is served at 8:30 am and coffee is available before breakfast too.

Staff (S1) explained that staff start with resident (R1) first, around 5:00 am, as it takes about 30 minutes to get R1 ready, including repositioning, and then she continues with the next resident, R2, who is also an early riser. Shift notes consistently show that R1 is the first resident staff help get ready in the morning and by 7:30 am, (5) of (6) residents are generally ready for the day at 7:30 am. S2 stated that resident (R3) is not a morning person and likes to wake up right before breakfast. Shift notes reflect that R3 is generally the last resident to wake up in the morning. R3 stated to LPA's that she wakes up around 8-8:30 am.

Interview with (1) resident revealed that staff will enter her room around 6:00-7:00 am to wake her up, and if she wants to sleep in longer, she will notify staff and they will listen and leave her alone. Another resident stated she does not want to miss breakfast time because she loves coffee. Another resident stated she wakes up at 6:30 am and would like to sleep a little longer. A third resident stated she wakes up around 6:30 am and would prefer to sleep a little longer; however, stated that staff would let her continue sleeping until 7:00-7:30 am if she would like, and staff will get clothes ready for her.

Staff (S3) informed LPA's that they do have a schedule, "but it is not a military schedule." and explained residents are allowed to decline and stay in bed if desired. Administrator explained that residents wake up around 7:00 am to get ready for breakfast, explaining the residents love coffee and want to wake up to socialize and drink coffee.

cont on 9099C(3)..

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 25-AS-20211217151503

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BLUEBERRY HILL SENIOR LIVING, INC.	FACILITY NUMBER: 342700821
	VISIT DATE: 03/04/2022

NARRATIVE

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9099C(3).Family member interviewed stated..residents do wake up early around 6:30- 7:00 am, but explained that staff needs to do vitals and give medications to residents in the morning.

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

Allegation: Licensee does not did not treat residents with dignity and respect.

LPA's interviewed (5) residents. One resident stated that facility staff listens to her concerns.
A second resident stated that staff are responsive to residents' needs and she can communicate well with them. A third resident indicating staff treats her independently and are kind and respectful, stating "there's good staff here".

LPA's interviewed (2) resident family members. One family member indicated that staff are very accommodating and provide lots of privacy for her sister, who does not have any issues with the facility. A second family member stated the facility treats the residents well, includes daily activities and denied having any issues with staff and/or the facility.

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

There are no deficiencies cited on this report.

Exit interview conducted with Administrator, Keith Hamric and staff, Megan Hamric, by phone. Administrator authorized caregiver on site, to sign today's reports.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC9099 (FAS) - (06/04)

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