345003010-11-1-2023-59-AS-MSEY-CXTUYA-20231122145937

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345003010
Report Date: 11/01/2023
Date Signed: 11/01/2023 03:10:55 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
08/14/2023 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20230814113258

FACILITY NAME:	OHANA CARE HOME		FACILITY NUMBER:	345003010
ADMINISTRATOR:	MITITI, DAN		FACILITY TYPE:	740
ADDRESS:	8254 MOSS OAK AVE		TELEPHONE:	(916) 879-0879
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 4	DATE:	11/01/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Dan Mititi		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility is violating resident's personal rights by not allowing visitors

INVESTIGATION FINDINGS:

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On 11/1/23, Licensing Program Analyst (LPA) Kevin Mknelly spoke to Administrator, to deliver complaint findings for the above allegation.

LPAs, Kevin Mknelly and Sabrina Calzada, reviewed resident records, facility records and conducted extensive interviews.
LPA finds that the allegations cited above are substantiated.

R1 was admitted on 8/5/23 and discharged on 8/20/23. R1 was diagnosed with physical, cognitive and communication disabilities.
R1 documents review found R1 had a Advanced Healthcare Directive which would grant their designated agent authorities of decision making when R1’s primary physician determines that R1 is unable to make their own healthcare decisions. Documents and interviews found that no such designation was recorded.

Report continued

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

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 59-AS-20230814113258

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OHANA CARE HOME	FACILITY NUMBER: 345003010
	VISIT DATE: 11/01/2023

NARRATIVE

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Interviews found that R1’s family members and the licensee thought that given R1’s cognitive and communication deficits, that R1 might be adversely affected by too many visitors or visits that were too long. There was no records of a doctor’s determination regarding the length or frequency of visits. The preponderance of attempted visitor statements also found that R1 was not asked, at the time of each attempted visit, if R1 wished to receive the visitor.

In response to the frequency of visitors for R1, the licensee modified their visitation policies, instituting a visits by appointment only policy. As a result, visitors for R1 who did not make an appointment to visit R1 were, at times, turned away.

The licensee did not submit the visitation policy change to their plan of operations to Community Care Licensing for review.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

Report reviewed with Administrator . Copy of this report and appeal rights provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20230814113258

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OHANA CARE HOME	FACILITY NUMBER: 345003010
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/29/2023 Section Cited CCR 87468.1(a)(11)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities (11) To have their visitors, … permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement was not met based on	1 2 3 4 5 6 7	Licensee will submit a plan for review of residents's decision making for visitors and a policy for staff to verify with residents at all times, unless there are legally designated visit restrictions, when a visitor arrives during visiting hours. Licensee will also sumit proof of this training
	8 9 10 11 12 13 14	Records and interviews which found restrictions to R1's visitation. This posed a potential risk to R1,	8 9 10 11 12 13 14	by the POC date of 11/29/23.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
08/14/2023 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20230814113258

FACILITY NAME:	OHANA CARE HOME		FACILITY NUMBER:	345003010
ADMINISTRATOR:	MITITI, DAN		FACILITY TYPE:	740
ADDRESS:	8254 MOSS OAK AVE		TELEPHONE:	(916) 879-0879
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 4	DATE:	11/01/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Dan Mititi		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility isolates resident while in care

INVESTIGATION FINDINGS:

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** Amended 11/22/23** On 11/1/23, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Administrator.
LPA conducted records review and extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.
Interviews conducted found that while there was disagreements between licensee and visitors at times, R1 was allowed movement and participation with others in the home, allowed access to home health therapists, allowed some visitors and was in contact with family.
Interviews with R1, on 8/16/23 and 10/26/23, found that R1 at times felt they had too many visitors, and R1 could not recall/ or state what their specific wishes were for who is to visit nor how long they should visit.
As a result of this investigation, LPA finds allegation to be (US)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.
Amended report emailed to licensee with signed copy return requested.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

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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