342700878-10-25-2022-25-AS-MSEY-CKQMET-20221031093316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700878
Report Date: 10/25/2022
Date Signed: 10/25/2022 05:20:44 PM

Unsubstantiated

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
08/22/2022 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220822154340

FACILITY NAME:	SPLENDOR OAKS SENIOR LIVING #3		FACILITY NUMBER:	342700878
ADMINISTRATOR:	LEE, KEVIN		FACILITY TYPE:	740
ADDRESS:	5813 KENNETH AVE		TELEPHONE:	(916) 241-9603
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	12	CENSUS: 10	DATE:	10/25/2022
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Ann Williams		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

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Staff threw an item at a resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conclude investigation and deliver complaint findings to a complaint received on 8/22/22. LPA met with Ann Williams, lead caregiver, and explained purpose of inspection. LPA observed caregivers, Paulina and Alicia. Currently there are (10) residents and (0) residents are on hospice. LPA observed (3) residents to be watching television in the common areas during the inspection.

Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols and was wearing a surgical mask. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. During the investigation, LPA interviewed Administrator, House Manager, Lead caregiver, (1) caregiver, resident (R1) who is the subject of the complaint, (4) additional residents and family member of R1. LPA reviewed documentation pertaining to R1 including: physician's report, pre-appraisal, and care plan.

The results of the investigation are as follows:
cont on 9099D(1)...

Unsubstantiated

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: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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 5

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
08/22/2022 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220822154340

FACILITY NAME:	SPLENDOR OAKS SENIOR LIVING #3		FACILITY NUMBER:	342700878
ADMINISTRATOR:	LEE, KEVIN		FACILITY TYPE:	740
ADDRESS:	5813 KENNETH AVE		TELEPHONE:	(916) 241-9603
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	12	CENSUS: 10	DATE:	10/25/2022
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Ann Williams		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

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Staff are not providing adequate care and supervision
Staff placed a soiled diaper in a resident's face
Staff do not provide adequate food service
Staff are not providing comfortable accommodations to a resident

INVESTIGATION FINDINGS:

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During the investigation, LPA interviewed Administrator, House Manager, Lead caregiver, (1) caregiver, resident (R1) who is the subject of the complaint, (4) additional residents and family member of R1. LPA reviewed documentation pertaining to R1 including: physician's report, pre-appraisal, care plan.

Allegation: Staff are not providing adequate care and supervision. Complaint alleges resident has difficulty getting someone to assist her in the restroom and staff are leaving her in the restroom by herself.

R1 stated staff "help her sit down and sometimes they stay nearby" and sometimes they leave. R1 confirmed she uses a pendant necklace when she needs assistance. LPA observed R1 to have the pendant and when pressed for assistance, on 8/26/22, in LPA's presence, staff responded within 1 minute. Interviews with (4) other residents revealed that they receive good care and receive assistance when needeed and staff will attend to them "very quickly". LPA observed (3) staff to be present during day time inspections on 8/26/22 and on 10/25/22 and no resident to be requesting asisstance and not receiving it. Lead caregiver stated there are always (3) care staff during the day and (2) during the night and R1 will use the pendant necklace day and night in addition to staff checking on her every 2 hours. Both the Sheriff and Ombudsman visited R1 on/around 8/21/22 and both indicated they didn't see any issue with R1's care, with the Ombudsman requesting staff document any unusual or recurring incidences.

Based on inforamtion obtained, LPA finds the allegation to be UNFOUNDED.

cont on 9099A(C)(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: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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 5

Control Number 25-AS-20220822154340

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: SPLENDOR OAKS SENIOR LIVING #3	FACILITY NUMBER: 342700878
	VISIT DATE: 10/25/2022

NARRATIVE

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9099A(C)(1).. Allegation: Staff placed a soiled diaper in a resident's face. Complaint alleges that staff placed a soiled diaper in resident's face when assisting her in the bathroom.

Interviews with staff and Administrator/managers revealed that no care staff would place a soiled diaper in a resident's face. Lead caregiver stated she was at the facility on Sunday, 8/21/22 when the sheriff conducted a wellness check on R1, and stated the Sheriff stated he didn't see any concerns with care or supervision. Additionally, the Ombudsman visited R1 just after the Sheriff's visit and indicated he didn't see any issue with R1's care, but requested staff document any unusual or recurring incidences. Lead care staff was not aware of staff allegedly putting a soiled diaper in R1's face until the Sheriff's came out on 8/21/22. Also, Lead care staff did not hear R1 mention anything about staff placing a soiled diaper in her face but did her complain about the diaper being thrown at her in a bag. LPA also heard R1 discuss the diaper being thrown and did not hear R1 mention anything about a soiled diaper being placed near her face.

Based on information obtained, LPA finds the allegation to be UNFOUNDED.

Allegation: Staff do not provide adequate food service.
Complaint alleges that resident is served soup when she does not eat soup and when she requests a sandwich, she is told they do not have peanut butter.

R1 stated she "doesn't want soup and a half sandwich" and she likes peanut butter and jelly sandwiches and "sometimes staff will give her that". All staff interviewed stated that if a resident doesn't like the menu item served, staff will prepare an alternative dish for the resident. LPA observed the facility to have sufficient food, including peanut butter and jelly, on 8/26/22 and again on 10/25/22. (3) other residents interviewed stated that there are no concerns with the food service with (1) resident stating that the food is served in "small portions that are not proportionate".

Based on information obtained, LPA finds the allegation to be UNFOUNDED.

Allegation: Staff are not providing comfortable accommodations to a resident.

Complaint alleges R1 feels dogs are treated better than she is, staff gather in the area outside of her door and speak loudly to each other, and sometimes early in the morning, staff wake her up early and take her to the table before breakfast preparations have started.

cont on 9099A(C)(2)...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 25-AS-20220822154340

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: SPLENDOR OAKS SENIOR LIVING #3	FACILITY NUMBER: 342700878
	VISIT DATE: 10/25/2022

NARRATIVE

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9099A(C)(2)... (4) other residents interviewed stated they receive very good care and receive assistance when it's requested. Residents stated staff will wake them up and give them a bed bath before taking them to the dining area at 8:30 when breakfast is served. Staff interviews revealed that starting at 7:00 am, all residents get a sponge bath and their hair combed to prepare them for breakfast which is served at 8:30 am. Lead caregiver stated that staff will wake R1 up in the morning around 7:00 and R1 will do her own hair and is ready around 8:10 am every morning, but will wait in her room until breakfast is served at 8:30 am. Lead caregiver stated she has never heard R1 say that she is "treated worse than a dog". Lead care giver stated that staff will talk loudly only so resident can hear better and also due to the caregiver's accent so it is clearer to understand. Also, the television nearby is often turned on which could be adding to the noise level.

Based on information obtained, LPA finds the allegation to be UNFOUNDED.

Based on information obtained, LPA finds the above (4) allegations to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview. Copy of report left at facility.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 25-AS-20220822154340

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: SPLENDOR OAKS SENIOR LIVING #3	FACILITY NUMBER: 342700878
	VISIT DATE: 10/25/2022

NARRATIVE

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Allegation: Staff threw an item at a resident while in care
Complaint alleges that resident placed the soiled diaper in a bag after being assisted in the bathroom by staff, placed the bag by the door of her room, and then the staff member then threw the bag at her.

Physician's report dated 3/5/22 notes resident (R1) has a diagnosis of Dementia, can be confused or disoriented, can follow simple instructions and communicate needs and needs assistance with toileting and/or using incontinent products. Physician's report and interviews confirmed R1 has a visual impairment and is considered legally blind. Lead caregiver stated that R1 is "very independent and is doing well".

R1 was interviewed on 8/26/22 stated she is not sure which night shift staff it was but recently a staff threw a
diaper in a bag at her. R1 stated the bag didn't hit or hurt her and "the lady that threw the diaper might not work at the facility anymore".

Facility staff interviewed stated that R1 is capable of taking her diaper off but needs assistance also with toileting and staff will ask her to call for assistance, never requesting she put a soiled diaper in a bag by the door. Lead caregiver stated she observed a tied bag containing a diaper that was found inside R1's door prior on/around 8/21/22 when the incident allegedly occurred and was reported to local authorities. A copy of the sheriff report was not available.

LPA was unable to interview any NOC shift staff and another staff (S1) was no longer working at the facility.

Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview. Copy of report left at the facility.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC9099 (FAS) - (06/04)

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