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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701159
Report Date: 01/03/2023
Date Signed: 01/12/2023 09:57:48 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
10/24/2022 and conducted by Evaluator Kesha Lewis
COMPLAINT CONTROL NUMBER: 27-AS-20221024150556
FACILITY NAME:BEATRICE SENIOR CAREFACILITY NUMBER:
342701159
ADMINISTRATOR:MITITI, BIANCAFACILITY TYPE:
740
ADDRESS:8901 MELODIC CTTELEPHONE:
(916) 270-3961
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 5DATE:
01/03/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Beatrice Clark TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff do not distribute residents' medications as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kesha Lewis arrived unannounced to finish tne complaint allegation Listed above. LPA was meet by Staff and administrator. LPA explained the purpose of today's visit.
The investigation was conducted by LPA Lewis and consisted of reviews of the facility records and interviews with facility management and staff. Other witnesses were contacted and interviewed.

The complaint allegations listed above were investigated. The facility staff, management and other witnesses were interviewed by LPA Lewis. Other witnesses interviewed provided conflicting information on the allegations.

LPA Lewis observed during file review that the MAR'S (Medication administration records) were marked as complete but during a physical count of the medication there was more medication present then days left of bottle. Neither staff or administrator could say definitively why the medication count was incorrect.

The investigation concluded, based on interviews, inspections, and file reviews the allegations were substantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred

Based on LPA’s observations and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are determined to be SUBSTANTIATED.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies are being cited. Exit interview held, a copy of report given during today’s visit.


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
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 2
Control Number 27-AS-20221024150556
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: BEATRICE SENIOR CARE
FACILITY NUMBER: 342701159
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2023
Section Cited
CCR
80075(k)
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80075Health Related Services (k)The following requirements shall apply to medications which are centrally stored: (7) The licensee shall ensure the maintenance, for each client, of a record of centrally stored prescription medications...This requirement was not met as evidenced by:
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Licensee will have an inservice training to ensure medication records are reviewed consistenly, discontinued medications will be correctly documented. Licensee to send an in-service sign in sheet to LPA by POC due date.
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Based on observations and records review, the licensee did not ensure client records were maintained, medication in bottle did not match MAR. Which poses a potential health and safety 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: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2