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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701211
Report Date: 07/19/2023
Date Signed: 08/02/2023 01:32:55 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/10/2023 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230710120826
FACILITY NAME:STEWART OAKS VILLAFACILITY NUMBER:
342701211
ADMINISTRATOR:FERREIRA, MELANIEFACILITY TYPE:
740
ADDRESS:1099 STEWART ROADTELEPHONE:
(916) 222-1010
CITY:SACRAMENTOSTATE: CAZIP CODE:
95864
CAPACITY:6CENSUS: 4DATE:
07/19/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Melanie FerreiraTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility does not have adequate staff to meet residents needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced on 07/19/2023 at 8:45 am to open a complaint and deliver complaint findings, LPA met with Administrator, Melanie Ferreira, and explained the purpose of the visit.

Throughout the course of the investigation, LPA Martinez conducted interviews and reviewed resident files. This investigation revealed the facility work week schedule is as follows: AM shift- one staff from 6:00 AM to 2 PM; PM shift one staff-2PM to 10PM; and NOC shift- one staff 10PM to 6AM. The weekend schedule is staggered, which consists of one shift from 6AM to 2PM, and a staggered shift from 8AM to 6PM, which leaves a two hour gap with one staff only. A 2PM to 10PM shift, and a staggered shift from 10PM to 6AM, which leaves a 4 hour gap with one staff only. The facility has a live in staff, however, when not scheduled to work they may be off the facility Premises and not available to work.

Continued...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
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 4
Control Number 27-AS-20230710120826
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: STEWART OAKS VILLA
FACILITY NUMBER: 342701211
VISIT DATE: 07/19/2023
NARRATIVE
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During today's visit there was one care staff working, and the Administrator was present. The Administrator was scheduled to complete their administrator duties and oversee care giving duties. LPA Martinez observed the Administrator making meals, providing care to residents, and cleaning. In addition, LPA observed care staff 1 (S1) providing care to the residents during today's visit. As a result, the Administrator was not conducting their administrator duties and one staff, S1, was attending to four residents. As a result, the facility did not have sufficient staff during today's visit to complete all facility work duties.

It was also learned during interviews that resident 1 (R1) requires two hands on assist with transfers and mobility. Additionally, R1's LIC 602 physician's report states R1 is bed bound and not able to transfer out of bed independently. However, facility staff reported R1 is able to ambulate with staff assistance when feeling well and not feeling weak. On today's visit, LPA Martinez observed R1 being transferred, which required two full hands on assist from the Administrator and S1. LPA Martinez observed very little assistance from R1 during the transfer. Moreover, during the transfer, the Administrator had to stop the transfer, and walk to the staff live in room, and ask staff 2 (S2) if they will be willing to work during the transfer. S2 was not scheduled to work, and does not have to assist with care giving although S2 assisted with R1's transfer, and the Administrator provide care and supervision to the other residents. It was also learned there is not always two care staff working at every shift during the weekends, which R1 requires two hands on assist leaving without their required care and supervision.

Due to this visit and LPA Martinez's observations, it was determined the facility does not have sufficient staff to meet the residents needs. In addition, it was determined the Administrator does not have the sufficient time to complete Administrator duties. Moreover, a case management was conducted on July 19, 2023 in regards to not maintaining resident records and conducting re-assessments.

As a result of this investigation, the Department finds this allegation to be Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations.

An exit interview was conducted, and a copy of the 9099 report, LIC 9099-D, and appeal rights were given to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20230710120826
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: STEWART OAKS VILLA
FACILITY NUMBER: 342701211
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2023
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidence by: Based on observation and file review, and interviews: The Licensee did not ensure
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The Administrator agrees to provide a weekly schedule that reflects staffing hours. First weekly schedule was provided to LPA Martinez on 07/19/23. Administrator agrees to continue to email weekly schedules until 08/31/23.
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the facility had a sufficent amount of staff working at all times. This posed an immediate health and safety risk to residents in care.
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Administrator agrees to provide LPA Martinez a staffing plan that will meet the needs of the residents by 07/28/2023.
08/02/2023
Section Cited
CCR
87507
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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.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4