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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347000389
Report Date: 06/16/2022
Date Signed: 06/16/2022 01:32:01 PM

Unfounded


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
03/14/2022 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220314163537
FACILITY NAME:ATRIA EL CAMINO GARDENSFACILITY NUMBER:
347000389
ADMINISTRATOR:KIMBERLY HAGENFACILITY TYPE:
740
ADDRESS:2426 GARFIELD AVETELEPHONE:
(916) 488-5722
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:325CENSUS: DATE:
06/16/2022
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Kimberly Hagen, Administrator TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility is not allowing resident to manage own medications
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint the department received on 3/14/2022. LPA met with Kimberly Hagen, Administrator, and explained purpose of inspection.

Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and confirmed the number of positive cases currently at the facility. 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: N95 mask.

During the investigation, LPA interviewed Administrator, (2) Regional Nurses, resident (R1), resident's representative. LPA reviewed the following documentation pertaining to resident (R1) including, but not limited to: physician's reports, care plan, medications lists, copy of faciliy medication policy and admission agreement. Additionally, LPA consulted with a Department Clinician.

Cont on 9099C(1)..
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
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 3
Control Number 25-AS-20220314163537
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: 06/16/2022
NARRATIVE
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Allegation states that resident has had the facility manage his medications for 2 years and has concerns about staff turnover and lack of supervision of the medication staff and has requested to manage his own medications. The facility is denying his request and has told him this is not possible. Resident states he is aware of all the medications he needs to take and the times he is required to take them. Resident has been reassessed and his physician has indicated resident can manage their own medications.

The results of the investigation are as follows:

Regional Nurse, Alisa Salluce, indicated on 3/22/22 that Regional Nurse, Cindy Barnes, consulted with her prior to assessing resident the first time to determine if resident could identify the medications he takes, and the reason and side effects of each one. Both regional nurses stated that several opportunities were given to resident who was not able to identify the majority of the medications being taken, or the reason or side effects of each one. Additionally, both regional nurses stated that Regional Nurse Barnes reached out to resident's Physician's Assistant to come in to the facility to assess resident with her, but it was not agreed upon. Following the phone call, resident's Physician's Assisted then immediately rescinded, on 3/14/22, her prior authorization, noted on the physician's report, allowing resident to mange his own medications. LPA observed fax documentation showing the authorization was rescinded from 'Yes" to "No" for resident to manage his own medications. LPA observed that resident's physician's Assistant wrote an order, effective 3/30/22, for resident to manage his own medication with the assistance of his daughter.

Regional Nurse Barnes stated that she provided resident with two different opportunities in March 2022 to identify his meds and explain what each medication is for and the side effects and resident was not able to identify all of the meds he takes, and stated "he needs to be able to identify and know what meds he takes". They would also still need to provide supervision to ensure that resident is taking them per doctor's orders. Administrator, Kimberly Hagen, stated she spoke with resident on 4/15/22 and explained that if staff is supervising him while he takes medications that are prepared by resident's family member, they are still supervising him, and resident must be enrolled in the medication program.

On 5/13/2022, LPA had a virtual meeting with resident, resident's representative, Administrator, and Regional Nurse Barnes to discuss the matter of resident managing his own medications further. Resident's representative explained that resident's physician and she and resident agreed that resident will have a check-list of what meds to take at which time to be able to manage his own medications. prescription.

cont on 9099C(2)...
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 25-AS-20220314163537
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: 06/16/2022
NARRATIVE
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Regional Nurse Barnes stated that resident needs to be able to identify his medications and he takes a lot of them, explaining that resident is currently managing his PRN meds in his room and the doctor keeps giving him more and some are prescription. Administrator stated on 5/13/22 that resident refused to discuss what medications any further with staff.

LPA explained that the Department's nurse also reviewed the request for resident to manage his own medications and the facility would need to "develop a care plan that addresses his needs, restricted health condition and medications" and the care plan should indicate how to meet all of these requirements.

Resident and resident's representative stated during the meeting on 5/13/22 that resident does not have to show the facility he can identify each medication he takes to be allowed to manage his own medications.

LPA reviewed documentation of "Medication Policy" signed on 12/17/2019 by resident which says residents "can keep medicine in their apartments only if you manage all of your medications". Regional Nurse Barnes stated that they have Title 22 regulations to follow with the state as well as their own policy and cannot allow resident to manage his own medications if he cannot identify them and express his understanding of the reason for the medication and the side effects of usage.

Based on information obtained during the investigation, LPA finds the allegation to be UNFOUNDED- A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted. Copy of report provided to Executive Director.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3