347000958-10-27-2022-25-AS-MSEY-CKQLJH-20221031084756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347000958
Report Date: 10/27/2022
Date Signed: 10/27/2022 02:37:20 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
09/15/2022 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220915083909

FACILITY NAME:	GRANNY'S COTTAGE		FACILITY NUMBER:	347000958
ADMINISTRATOR:	ADALBERTH BANCU		FACILITY TYPE:	740
ADDRESS:	7717 DEANTON COURT		TELEPHONE:	(916) 729-9319
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 4	DATE:	10/27/2022
		UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Adalberth "Albert" Bancu, Administrator		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Facility refused to take resident back after hospitalization.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver investigation findings to a complaint received on 9/15/22. LPA met with Floarea Bancu and Sabinel Bancu, caregivers. LPA met with Albert Bancu, Administrator, and explained purpose of inspection, when he arrived at the facility at approximately 1:50 pm. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols and was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE): surgical mask. LPA confirmed there are no current positive Covid cases and the facility has a pending clearance from county public health from the positive case in September 2022.

During the investigation, LPA interviewed the Administrator, a current resident (R2) and attempted to speak to a health care representative. LPA reviewed documentation pertaining to resident (R1), including: physician's report, care plan, fax communications to/from physician, incident report submitted to the Department.on 9/13/2022 when R1 was sent to the hospital.

The results of the investigation are as follows:

Substantiated

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: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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 25-AS-20220915083909

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: GRANNY'S COTTAGE	FACILITY NUMBER: 347000958
	VISIT DATE: 10/27/2022

NARRATIVE

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9099C(1). Complaint alleges that resident was refused acceptance back to the facility following a hospital psychiatric evaluation, and since resident is diagnosed with dementia, psychiatric hospitalization was not an appropriate placement.

Resident (R1) moved to the facility on/around 8/9/2022. Physician's plan, dated, 8/8/2022 notes resident has a diagnosis of Mild Cognitive Impairment, fractured ankle, Bipolar, is sometimes confused and depressed and is not able to leave the facility unassisted. Physician's report also notes that resident does not have inappropriate, aggressive, wandering or sundowning behavior and is able to follow instructions and communicate needs.

Resident's initial care plan, dated 8/12/2022, indicates that resident may be forgetful, display agitation and become combative during Bipolar episodes or mood swings, and needs medication to help manage behaviors. Administrator wrote a detailed letter on 8/15/2022 to inform resident's physician to inform of some changes in her condition, including increased pain, constipation, anxiety and difficulties sleeping during the day and night, coughing and confusion around medications. Resident's confusion with asking for medications just after they were issued was causing her to yell at caregivers. Medications were adjusted on 8/16/2022 to address these concerns.

Administrator wrote another detailed letter to resident's physician on 8/23/2022 requesting advise on how to handle changes in her condition related to: shortness of breath, fatigue, right swollen foot and left foot without edema, resident preferring to sleep face down and is coughing frequently during the night. Facility phone and fax contact information was provided in request. Administrator stated the doctor responded the next day and prescribed medications to address the ongoing concerns.

LPA reviewed a fax sent to the facility on 9/7/2022 with an updated medication list. On 9/12/2022, medications were adjusted again and Ropinerole was replaced with Zyprexa and Ativan was replaced with Vistaril 50 mg. Physician requested that facility keep her informed of the results of Zypexa and to plan to reassess resident in 24-48 hours. Facility called on 9/13/22 and advised the medications were not helping improve resident's condition. R1 called the ambulance herself to obtain a psychiatric evaluation at the hospital. On 9/16/2022, resident's medications were adjusted again but at the hospital. Administrator spoke with R1's family member who indicated R1 was still not sleeping better after 3 days in the hospital and medication changes.
cont on 9099C(1)..

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20220915083909

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: GRANNY'S COTTAGE	FACILITY NUMBER: 347000958
	VISIT DATE: 10/27/2022

NARRATIVE

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90099C(2)..
Incident report dated 9/13/2022 reports resident to have combative behaviors towards staff and disturbing other residents. Report states that resident's psychiatric medications did not work effectively and both staff and the resident decided to have resident sent to the hospital for further psychiatric evaluation after contacting resident's physician and family members who have Power of Attorney. Report states that resident will be medically supervised until her psychiatric condition becomes stable.

Administrator stated on 9/21/2022 that resident was "waking everyone almost every night" and he was receiving complaints from residents and tried to work with the doctor. Administrator added the facility tried for 1 month and "the hospital refused to send her to a medical/psychiatric facility as they said it would be more difficult". Administrator added the resident "decided to go to the hospital herself and wanted to overdose herself with Norco" and "we said no"- and the resident didn't know how to live in a facility and her condition changed also, asserting "the issue was the hospital refused to give me a guarantee (R1) wouldn't be exposing other residents to her behaviors, stating "It's (R1's) rights vs. residents' rights".

Another (R2) resident stated R1 would disrupt the caregivers when they were caring for other residents, demanding her medications when she had just received them, and also bother other residents by going into their rooms at night a lot.

Based on information obtained, LPA finds that although the facility tried to work with the doctor in addressing concerns with R1, and medication changes were made, the facility did not issue a 30-day notice in writing to the resident, per Regulation 87224, for the reason(s) resident was being evicted.

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

Exit interview. Copy of report and appeal rights provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 25-AS-20220915083909

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: GRANNY'S COTTAGE	FACILITY NUMBER: 347000958
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/27/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/10/2022 Section Cited CCR 87224(a)(4)	1 2 3 4 5 6 7	87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5) (4) If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator agree to read Regulation 87224 and submit a signed statement to CCLD by 11/10/2022 that it is understood. Licensee/Administrator agree to more carefully evaluate potential residents for their suitability prior to admiission and communicate possibility of eviction to families before admitting if the resident is displaying behaviors that are not suitable.
	8 9 10 11 12 13 14	Based on interview with Administrator and documentation reviewed, the Licensee did not ensure that a 30-day written notice was issued to resident (R1) on/around 9/13/2022, when resident went to the hospital for a psychiatric evaluation, which posed an potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	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: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC9099 (FAS) - (06/04)

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