347000389-5-17-2022-25-AS-MSEY-CEPLCK-20220523083828

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347000389
Report Date: 05/17/2022
Date Signed: 05/17/2022 02:22:15 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
01/18/2022 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220118151104

FACILITY NAME:	ATRIA EL CAMINO GARDENS		FACILITY NUMBER:	347000389
ADMINISTRATOR:	KIMBERLY HAGEN		FACILITY TYPE:	740
ADDRESS:	2426 GARFIELD AVE		TELEPHONE:	(916) 488-5722
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	325	CENSUS: 172	DATE:	05/17/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Kimberly Hagen, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility does not have adequate supervision.
Staff did not provide adequate food service to residents.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint received on 1/18/2022. LPA met with Kimberly Hagen, Administrator. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN95 mask.

During the investigation, LPA interviewed Senior Executive Director (SED), Kimberly Hagen, Business Office Director (BOD), Culinary Director, (1) Culinary staff, (3) Med-Techs, and (3) residents and reviewed documentation including: facility dining menus for January 2022, staffing levels and an Unusual Incident/Injury report (LIC624).

The results of the investigation are as follows:

cont on 9099C(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: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

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 4

Control Number 25-AS-20220118151104

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: ATRIA EL CAMINO GARDENS	FACILITY NUMBER: 347000389
	VISIT DATE: 05/17/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Facility does not have adequate supervision. Complaint discusses three specific concerns as follows:

Due to insufficient staffing the staff do not turn in required paperwork for long-term care insurance and the insurance company has attempted to decline her claim.

Business Office Director confirmed she processes long-term care paperwork and each department submits specific paperwork to her which is forwarded to the respective insurance company before the end of each month. BOD stated it is "a very tedious" process as she has to fax paperwork and then email it to the insurance company and then send it by USPS also and has 5 days to do so. BOD stated that if the paperwork is late on her end, she will adjust the billing so resident only pays what they would have paid or will pay after the reimbursement. BOD stated she hired an assistant in February 2022 to help with the paperwork.

Many residents are not receiving their showers and not being provided with the care they are paying for.

Med-Techs (3) were interviewed on 2/24/2022. One Med-Tech stated sometimes there are 2-4 showers scheduled on a shift and we will try to accommodate them". A second Med-Tech stated "Sometimes it's a problem- we help as needed and work as caregivers if someone needs shower help. On Hall A, there is 1 male caregiver and sometimes there is a delay if a female resident needs a shower and prefers a female caregiver. On Hall B, 1 -2 caregivers is usually okay since the residents are more independent. "Hall B and C are the busiest and there are a lot of pendant pushes for escorts, toileting and showers". Residents are asking for more help on Hall B and C. Staff has communicated to management that from 6 am- 9 am and from 4 pm- 7 pm, 3 caregivers are needed. 1 Med-Tech is always sufficient at any time." A third Med-Tech stated the facility uses agencies, if needed, so there are 3 Med-Techs on each shift, one for each building, A, B and C, and the average wait time is 5-10 minutes, and the mornings are the busiest. This Med-Tech stated that sometimes staff doesn't clear the pendant button, and sometimes residents refuse their scheduled shower.

cont on 9099C(2)...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 25-AS-20220118151104

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: ATRIA EL CAMINO GARDENS	FACILITY NUMBER: 347000389
	VISIT DATE: 05/17/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

9099C(2)..LPA interviewed (3) residents. One resident stated that she receives a shower twice weekly and there is a helper that helps her, showers are given as scheduled and are "always on the right day". A second resident stated she receives shower standby assistance, and a third resident- indicated he does not use the pendant to request assistance and staff will attend to him in 5 minutes or less if assistance is requested.

Resident stated one day she found resident (R1) laying in the hallway alone, after falling, and it took staff 15-20 minutes to respond.

LPA discussed LIC624 submitted to the Department for resident (R1)- who fell on 11/18/2021 near Building C mailboxes. The LIC624 notes that emergency medical technician's arrived and assessed resident who was then sent to the Emergency Room. LPA discussed additional information with SED who stated resident became a two-person assist and needed a higher level of care.

Two Med-Techs were interviewed about the allegation. The Med-Tech referenced in LIC624 stated he was off the day R1 fell and stated, "it's not likely she would be laying in the hallway for 15-20- minutes and was not seen". This Med-Tech stated R1's balance was not the best and so staff did status checks on her and staff still have to call 911 for every unwitnessed fall. A second Med-Tech stated she was unsure of reasons why resident may have been waiting on the floor for 15-20 minutes after falling and did not have any additional information.

Based on information obtained through interviews and documentation reviewed, LPA finds the above allegation to be UNSUBSTANTIATED- meaning 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.

Allegation: Staff did not provide adequate food service to residents. Allegation has two parts.

Allegation asserts that at breakfast on 1/18/2022, there was no chef and all the food was pre-made and reheated which causes the food to be of very poor quality. Residents complain the food is served cold and due to insufficient kitchen staff residents wait a long period of time before food is served.

cont on 9099C(3)...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 25-AS-20220118151104

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: ATRIA EL CAMINO GARDENS	FACILITY NUMBER: 347000389
	VISIT DATE: 05/17/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

9099C(3)...Culinary Director stated, when asked about staffing shortages in the kitchen, "All of our staffing in the kitchen/dining is from an agency except for (1) staff from Atria." Culinary Director was asked about food being pre-made and reheated and stated, "We have a special #1 and #2 which can be served quicker.... and "everything is made fresh- only dessert is served the next day and no more than 3 days after it's made. We don't reheat to serve- the food quality has stayed the same- nothing has changed".

A lead server stated , "We have a few Atria staff and a few temporary staff from the agency and there has never been a time when there are no staff in the dining room to serve". The lead server stated, when asked about resident complaints, "We tell the chef. Every month, we host a Food for Thought meeting- residents can voice their concerns." The Culinary Director also stated, "Food for Thought" meeting isheld in the main dining room on the first Thursday of the month so residents can voice their opinions/concerns about food service." LPA interviewed (3) random residents who were sitting in the dining room on 2/24/2022. The first resident stated the food is good, the servers provide timely service, and the food is fresh. A second resident stated the has no complaints about the food service. A third resident- "for the most part it is good" and "yes, we have to wait sometimes- it's hard for the contract people to know what to do" and "once in a while it's not hot". SED and BOD confirmed, while looking through electronic personnel files, that 1/18/22 was a Tuesday and provided names of (5) staff who began their shift on that morning in the kitchen.

Allegation asserts the facility is not serving many vegetables to the residents, and the main chef refuses to serve them V8 juice even though they have the juice in storage.

Culinary Director stated in an interview, “We substitute with a similar product if we can't get the juice. I couldn't get V8 juice”. Nothing has changed with the food served. We order all our vegetables and 90% of other food from (the same outside company). The quantity never changed."LPA reviewed (2) facility dining menus- on menu features always available items for breakfast, lunch and dinner and dessert, and the second menu features “Daily Specials” which offer a variety of foods to choose from, including a different soup, salad, entrée, dessert/fruit/fruit juice. Also offered at lunch and dinner are a “Restaurant’s Favorite” which feature an entrée, side and vegetable.

Based on information obtained through interviews and documentation reviewed, LPA finds the above allegation to be UNSUBSTANTIATED- meaning 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 provided to facility.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4