342701192-4-11-2024-27-AS-KHOS-D4DQU2-20240416122801

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701192
Report Date: 04/11/2024
Date Signed: 04/11/2024 12:22:35 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
03/08/2024 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240308101336

FACILITY NAME:	VITA BELLA ELDERLY CARE III		FACILITY NUMBER:	342701192
ADMINISTRATOR:	LABELLA, MARK		FACILITY TYPE:	740
ADDRESS:	6700 SUN RIVER DR		TELEPHONE:	(916) 490-0237
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY:	14	CENSUS: 12	DATE:	04/11/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Mark Labella and Cleopatra Gardiner		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff mismanages resident's medications.
Medications are made accessible to residents.
Staff are not meeting resident's incontinence needs.
Staff did not treat resident with dignity and respect.

INVESTIGATION FINDINGS:

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On 04/10/2024, Licensing Program Analyst (LPA) Pang Lee and Licensing Program Manager Czarrina Camilon-Lee arrived unannounced to this facility to conduct a complaint visit. LPA Lee and LPM Camilon-Lee met with administrator Mark Labella and direct care staff, Cleopatra Gardiner 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 12 with 2 facility staff. A brief interview was conducted with administrator Mark Labella

Allegation: Staff mismanages resident's medications.
It was alleged that facility staff mismanaged resident's medications. This investigation consisted of records reviewed, interviews with staff and residents. LPA Lee interviewed 5 out of 5 residents who denies the allegation that facility staff mismanages residents’ medication. Two facility staff also denied the allegation. Moreover, resident 1 (R1) denies the allegation and stated that (R1) knows what medication (R1) is given and has no concerns with the facility staff mismanaging (R1)’s Medications.
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: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20240308101336

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: VITA BELLA ELDERLY CARE III	FACILITY NUMBER: 342701192
	VISIT DATE: 04/11/2024

NARRATIVE

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LPA Lee also reviewed (R1)’s MAR log sheet and compared the MAR log sheet to (R1)’s medication and it was learned that resident’s medication matches and medications on the log sheet. Furthermore, LPA Lee conducted 3 medication audit and there were no discrepancies. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation was found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means 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 not meeting resident's incontinence needs.

It was alleged that facility staff are not meeting resident's incontinence needs. This investigation consisted of records reviewed, interviews with staff and residents. LPA Lee interviewed 5 out of 5 residents who denies the allegation that facility staff are not meeting resident's incontinence needs. Two facility staff also denied the allegation. On 03/13/2024, LPA Lee observed staff 1 (S1) providing incontinence care to two residents. LPA Lee reviewed 5 out of 5 Client Care Daily Checklist and records reviewed indicates that 5 out of 5 clients incontinence needs are provided. Moreover, (R1) denies the allegation that facility staff are not meeting (R1)’s incontinence needs. (R1) stated that (R1) is independent and does all (R1)’s ADL needs and that facility staff does help (R1) when needed. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation was found to be UNSUBSTANTIATED finding that the complaint allegations are UNSUBSTANTIATED means is 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 did not treat resident with dignity and respect.

It was alleged that facility Staff did not treat resident with dignity and respect. This investigation consisted of records reviewed, interviews with staff and residents. LPA Lee interviewed 5 out of 5 residents who denies the allegation that facility staff are not treating resident with dignity and respect. Two facility staff also denied the allegation. Moreover, resident 1 (R1) denies the allegation and stated that he/she has no concerns and does feel safe living at the home. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation was found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means is 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.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20240308101336

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: VITA BELLA ELDERLY CARE III	FACILITY NUMBER: 342701192
	VISIT DATE: 04/11/2024

NARRATIVE

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Allegation: Medications are made accessible to residents.

It was alleged that medications are made accessible to residents. This investigation consisted of records reviewed, interviews with staff and residents. LPA Lee interviewed 5 out of 5 residents and 2 out of those 5 residents admitted to the allegations. Two facility staff also admitted to the allegations. Throughout the investigation it was learned that (R1) was admitted to the facility on 02/09/2024 and residents’ medication came from the hospital with (R1). It was also learned that (S2) conducted an intake of (R1)’s medications that came with (R1) on 02/09/2024 and (S2) locked up those medications. Based on interviews, (R1) made arrangement with the bunker where (R1) lived prior to being admitted to the hospital and then from the hospital to this facility to have (R1)'s personal belongings delivered to the facility. (R1) admitted that when (R1)’s personal belonging arrived at the facility (R1) did not informed facility staff that (R1) has medications in (R1)’s personal belongings that was delivered. (R1) admitted that (R1) thought it was okay for (R1) to keep (R1)’s medication in (R1)’s room since it was okay for (R1) to keep (R1)’s medication in (R1)’s room when (R1) was living at the bunker. (R1) also admitted that (S2) did asked (R1) what was in (R1)’s garbage bags that was delivered and (R1) responded that they were only clothes and food in the garbage bags. Moreover, (S2) admitted that (S2) found (R1)’s medication in (R1)’s room the next morning when (S2) helped (R1) clean and un-bag (R1)’s personal belongings. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation was found to be UNSUBSTANTIATED finding that the complaint allegations are UNSUBSTANTIATED means is 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.

LPA Lee did issue a Technical Assistant to ensure that when residents belongings are delivered to the facility that facility staff will conduct an audit check list to ensure residents medications are not made assessable to residents in care.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiency is cited.

A copy of this report was provided, and LIC 811, the Confidential Names List.
Exit interview.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

LIC9099 (FAS) - (06/04)

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