342700835-2-23-2024-27-AS-KHOS-D34PCH-20240306101200

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700835
Report Date: 02/23/2024
Date Signed: 02/23/2024 03:16:56 PM

Unsubstantiated

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
01/11/2024 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240111134408

FACILITY NAME:	CITY CREEK ASSISTED LIVING		FACILITY NUMBER:	342700835
ADMINISTRATOR:	CALEB SUMMERHAYS		FACILITY TYPE:	740
ADDRESS:	6254 66TH AVENUE		TELEPHONE:	(916) 393-2324
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	121	CENSUS: 111	DATE:	02/23/2024
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Caleb Summerhays and Mel Dearing		TIME COMPLETED:	03:26 PM

ALLEGATION(S):

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Staff did not dispense medications to residents as prescribed.
Staff are improperly storing narcotics.

INVESTIGATION FINDINGS:

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On 02/22/2024 at 12:30 PM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA Lee met with administrator Caleb Summerhays and Mel Dearing and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 111. A brief interview with conducted with Nurse Mel Dearing, Social Services Director, Leslie Padilla and Resident Care Director, Aashana Pillaly.

Allegation: Staff did not dispense medications to residents as prescribed.
It was alleged that Staff did not dispense medications to residents as prescribed. This investigation consisted of records reviewed, and interviews with facility staff and Omnicare. It was learned that the facility was using “Quick MAR” to document and distribute residents’ medications. On December 11, 2023, the facility then switched to a new system called Point Click Care (PCC). LPA Lee interviewed 4 out of 4 facility staff who confirmed that the only difference in resident’s medication was the time the medications was given.
Continued LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

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-20240111134408

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: CITY CREEK ASSISTED LIVING	FACILITY NUMBER: 342700835
	VISIT DATE: 02/23/2024

NARRATIVE

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Based on interviews with Nurse Mel Dearing and Omnicare account Manager it was informed to LPA Lee that some resident’s medications, the doctors doesn't justify the specific time of when the medication is to be given to resident. Medications only states once a day, twice a day or 3 times a day. Residents’ medications were given at 8:00 AM if residents medication states once a day. Residents’ medications are given to residents at 8:00 AM and 5:00 PM if residents are to take their medications twice a day. If residents’ medications indicate three times a day, then resident’s medication are given to resident at 8:00 AM, 12:00 PM and 5:00 PM. Based on interviews with Omnicare, it was learned that usually the provider will send residents order to the facility and then the facility will send the order to Omnicare and Omnicare will enter the order and push the order through into PCC which will generate residents medication list for the facility. Based on records review 10 out of 10 residents’ routine medications were in both Quick Mars and PCC. Upon reviewing residents PRN medications in Quick Mars and PCC there were discrepancies due to the transition of the two programs. It was learned that Omnicare was working with the facility in auditing residents’ medication. Moreover, some of the residents' PRN medications are either discontinued or are new orders that has not been entered into PCC. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.

Allegation: Staff are improperly storing narcotics.

It was alleged that Staff are improperly storing narcotics. This investigation consisted of observations, records reviewed, and interviews with facility staff. LPA Lee interviewed 4 out of 4 Med-techs who denied the allegations. On 01/17/2024 complaint visit LPA Lee asked to look at Med Chats 1, 2, and 3. LPA Lee did not observe resident 1 (R1) and (R2) narcotics in any Med Charts. LPA Lee also looked at other residents’ narcotics in the med chart 1, 2, and 3 and it was learned that narcotics in the med carts are for residents residing in the facility. During today’s visit, LPA Lee also requested to look at Med Chart 1, 2 and 3. LPA Lee observed narcotics stored in the med cart are for residents who are still residing at the facility as well. In addition, LPA Lee reviewed (R1) LIC 622 Medication Destruction Record and it was learned that (R1)’s narcotics was destroyed on 12/01/2023 on the day that (R1) was deceased.

Continued LIC 9099-C

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20240111134408

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: CITY CREEK ASSISTED LIVING	FACILITY NUMBER: 342700835
	VISIT DATE: 02/23/2024

NARRATIVE

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LPA Lee also reviewed (R2) LIC 622 Medication Destruction Record and it was learned that (R2)’s narcotics was destroyed on 12/04/2024 on the day that (R2) was deceased. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.

There were no deficiencies observed or cited at this time. An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

LIC9099 (FAS) - (06/04)

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