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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347000389
Report Date: 08/24/2022
Date Signed: 08/24/2022 12:32:00 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, 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
04/26/2022 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220426122233
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: 169DATE:
08/24/2022
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Deborah Ahrens, BOD and Ingrid Weber, Memory Care Director TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Resident visitation rights are violated.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver complaint findings for a complaint received on 4/26/2022. LPA met with Deborah Ahrens, BOD and Ingrid Weber, Memory Care Director . Kimberly Hagen, Administrator joined by phone. 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 and confirmed there are currently multiple positive Covid cases at the community. 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: surgical mask.

During the course of the investigation, LPA interviewed the Administrator, Business Office Director, Memory Care Director, resident (R1), resident's POA, and another individual who knows R1. LPA reviewed documentation pertaining to R1 including, but not limited to: Physician's report, pre-assessment, initial care plan and care plan due to change in condition, General Durable Power of Attorney and Power of Attorney for Health Care for R1, emails from an individual who has visited with R1 and a text message sent from one individual to a second individual, who both had visited R1, describing a follow up phone call received on/around 4/22/2022 from the facility about their recent visitation.

The results of the investigation are as follows:

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

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
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 6
Control Number 25-AS-20220426122233
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: 08/24/2022
NARRATIVE
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Allegation: Resident visitation rights are violated.
The complaint alleges that when (2) visitors asked the facility if resident (R1) could join them for a lunch outing, with their mom, another resident, off site,. they were told by the Memory Care Director she would need to check with (R1's) family. The Memory Care Director followed up and sent a text to one of the visitors stating that they could no longer visit with (R1) due to Covid and they would have to wear a mask for outdoor visitation.

LPA reviewed several emails received from an individual who had visited with R1 in the Memory Care Unit on multiple occasions. The individual stated on 4/26/22, that she had visited with R1 the Friday before (4/22/22) and following the visit she received a text from another individual who had also visited with her that day, stating that they would not be able to visit again if they did not wear a mask both indoors and outdoors. The visitor stated that she has not always been diligent about wearing a mask inside due to another friend being hard of hearing that she also visited with.

LPA reviewed a subsequent email from the same visitor, dated 4/29/22, noting that she and another visitor were denied visitation with resident (R1) due to resident's family not granting permission and they were also not allowed to enter the Memory Care Unit to visit another resident (R2), who also resides in the Memory Care Unit, but had to visit outdoors where the facility staff brought R2 to meet them.

LPA reviewed a third email received on 5/7/22 where the same visitor states that she was again denied visitation inside the facility on 5/6/22 and was only permitted to visit outside the building with resident (R2). The email states that the visitor inquired with facility staff why she/they could not visit with R1 on the inside Memory Care patio and the staff did not provide an answer.

The Memory Care Director stated that she communicated with the daughter of R2 that since the (2) ladies visiting R1 "are always removing their masks", they would need to conduct any future visits outdoors. LPA reviewed a copy of a text message sent from the family member of resident (R2) to one of the visitors who had visited resident (R1) on 4/22/22. The text message states that it is a summary of the phone call made by a facility director to the family member of R2 with the following requests made: 1) Masks need to be worn at all times; 2) Indoor visits no longer allowed; 3) Outdoor visits still allowed but masks still need to be worn at all times; 4) Visiting with other residents is unfortunately not allowed due to not only Covid safety but for privacy as well; 5) if the (2) visitors wishing to visit with R1 are unmasked again, they will no longer be able to visit.
cont on 9099C(2)..
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 25-AS-20220426122233
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: 08/24/2022
NARRATIVE
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9099C(2)...R1's physician's report, dated 1/13/22, notes that resident has a diagnosis of Alzheimer's Dementia with behavioral disturbance and cannot leave the facility unassisted and also indicates that resident does not have any motor impairment that would require use of an assistive devise. Resident's initial assessment and care plans (2) note that resident is not a fall risk, does not require assistance with transferring and does not use an assistive/adaptive device.

POA stated that R1 is a social person and he is happy for her to have visitors, but he would like to know who his mother is visiting with due to a past history of people trying to take from her financially. Resident stated to LPA that there are some "wonderful ladies that always ask for me when they visit because they know I like to read." One email from one of the visitors describes how R1 likes to read and how she brings her new books.

Memory Care Director also stated that she has to notify and get authorization from R1's POA before allowing anyone to visit R1. Both the Memory Care Director and R1's POA confirmed that there is not a restraining order for visitation, preventing anyone from visiting or a conservatorship for R1 currently in place.

The Department issued Provider Information Notice (PIN) 21-48- ASC on 11/17/2021 entitled "Authority of Conservators and Agents under Powers of Attorney related to Resident Rights". The PIN states under "Residents' Rights to Visitors, Telephone Calls and Personal Mail": POAs typically do not address issues concerning visitation, telephone calls, or personal mail and therefore, agents are not authorized to restrict these rights. However, a POA agent can regulate visitation, telephone calls or personal mail only if: 1) the resident explicitly gave the agent the authority to regulate these issues in the POA and 2) the principal does not disagree with the choices the agent is making. Principals, even those with a cognitive impairment, retain the legal authority to control their health care and other personal decisions unless a court has taken that authority away. The Department reviewed the General Durable Power of Attorney of (R1) provided during the complaint investigation. While the document does grant power to resident's POA regarding mail receipt and services, it does not address visitation or telephone calls.

Based on information obtained during the investigation, the allegation is found 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.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency is cited on the 9099-D page.

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

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
04/26/2022 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220426122233

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:
08/24/2022
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Kimberly Hagen, Administrator TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility is not following current Covid-19 precuationary protocols.
INVESTIGATION FINDINGS:
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During the course of the investigation, LPA interviewed the Administrator, Business Office Director, Memory Care Director and another individual who visited resident (R1). LPA reviewed documenation including: emails and text messages sent from two individuals who visited R1. The allegation refers to visitors being asked to wear a mask even if visiting a resident(s) outdoors.

Memory Care Director stated that she communicated with the friend of (2) visitors of resident (R1) that since they are always removing their masks they would only be permitted to visit outdoors, and with a mask on. Emails and a text message reviewed reflect that the facility had discussed the requirement of visitors needing to wear a mask at all times. Provider Information Notice (PIN) 22-07, issued on 2/7/22, states that any time visitation is restricted, outdoor visitation must be allowed when the weather permits and where the visitor wears a well-fitting mask. It was not determined if the visitors provided proof of Covid vaccination or of a negative test result upon entering the facility; however, the facility offered outdoor visitation consistently and also requested the visitors wear a mask

Based on information obtained, the allegation is found 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 left with Administrator.


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Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 6
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
04/26/2022 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220426122233

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:
08/24/2022
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Kimberly Hagen, Administrator TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Resident is not appropriately placed.
INVESTIGATION FINDINGS:
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During the course of the investigation, LPA interviewed the Administrator, Business Office Director, Memory Care Director, resident (R1),and resident's POA. LPA reviewed documenation pertaining to R1 including, but not limited to: Physician's report, pre-assessment, initial care plan and care plan due to a change in condition, General Durable Power of Attorney and Power of Attorney for Health Care for R1. Resident (R1) began residing in the Memory Care unit at the faciltiy on/around 3/2/2022.

Resident's physician's report, dated 1/13/22, notes resident has a diagnosis of Alzheimer's Dementia with behavioral disturbance, is confused/disoriented, is able to follow simple instructions and cannot leave the facility unassisted. Resident's initial care plan, dated 3/2/22, indicates that resident requires assistance with grooming, nutritional supplements, hydration and stand-by/remind assistance 3 times daily. Care plan dated 3/29/22 reflects the same care needs with the addiitional service of "status checks" where staff will observe resident's condition once per shift and report changes to resident, family member and physician. POA stated on 4/29/22 that resident has been diagnosed with Dementia by a geriatric physician and resident's past behavior has supported this diagnosis, even though resident may appear to be high functioning to those that don't know her well. Although resident has a medical diagnosis of Dementia, she did not sign the facility's "Secured Environment Addendum" or voluntary statement of entry into a secured environment, as required by Health and Safety Code§1569.698(f) by an individual who is not conserved. (A citation to be issued on a separate report dated 8/24/22). Facility staff stated that resident cannot reside in the Assisted Living Unit due to behaviors associated to her Dementia diagnosis. Physician's report notes that behaviors have improved with medications.

Based on information obtained, the alleagation is found 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.

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: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 25-AS-20220426122233
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/06/2022
Section Cited
CCR
87468.1(a)(11)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement is not met as evidenced by:

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Licensee/Administrator agree to conduct a training with department managers to discuss POA's and visitation rights in general for residents. Documentation of agenda/attendees to be provided to CCLD by 9/30/22.
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Based on interviews conducted and documentation reviewed, the Licensee did not ensure that resident's (R1) was able to visit with visitors who requested to visit with her on 4/29/2022 and on 5/6/2022, which posed a personal rights violation to residents in care.
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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.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6