347001322-6-2-2021-27-AS-KMKY-C3TUC7-20210609152728

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001322
Report Date: 06/01/2021
Date Signed: 06/02/2021 09:34:52 AM

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
09/28/2020 and conducted by Evaluator Melana Llopis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200928142038

FACILITY NAME:	LOVE & CARE FOR ELDER		FACILITY NUMBER:	347001322
ADMINISTRATOR:	SUIUGAN, ELIZABETH		FACILITY TYPE:	740
ADDRESS:	7931 COOK RIOLO ROAD		TELEPHONE:	(916) 723-2912
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY:	6	CENSUS: 6	DATE:	06/01/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator, Rebecca Szabo		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not follow resident's hospice care plan.
Staff did not ensure resident was properly cleaned after feeding.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melana Llopis arrived at the facility unannounced on 06/01/2021 to deliver findings for a complaint the Department received on 09/28/2020.
LPA met with Administrator, Rebecca Szabo and explained the purpose of the visit.

Throughout the course of the investigation, Community Care Licensing (CCL) conducted multiple interviews and reviewed documentation pertinant to the allegations listed above.

The results are as follows:

***Continuation on LIC9099-C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021

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 27-AS-20200928142038

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: LOVE & CARE FOR ELDER	FACILITY NUMBER: 347001322
	VISIT DATE: 06/01/2021

NARRATIVE

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Allegation: Staff did not follow resident's hospice care plan.
Complaint alleged the facility was feeding the resident (R1) solid foods. On 07/17/2019 R1 moved into the facility with a primary diagnosis of Huntington disease. R1's medical assessment indicates R1 has a special diet of pureed foods only. In September 2020 R1 began receiving hospice care services. R1's hospice care plan and resident assessment indicates R1 "does not converse but is able to say one/two words." Facility staff stated resident did not make requests for restricted foods outside of their special diet. On 05/26/2021 LPA spoke with the National Director of Licensing for Bristol Hospice who stated the nurse's notes did not indicate R1 was receiving solid foods orally from the facility staff. On 05/27/2021 LPA Llopis interviewed three (3) care staff specifically assigned to R1 who stated they received training in pureing foods for residents, and only fed R1 pureed foods. LPA attempted to contact R1's family member on 05/24/2021, 05/27/2021 and 05/28/2021 but was unable to make contact for an interview. No further evidence could be provided.

Allegation: Staff did not ensure resident was properly cleaned after feeding.
Complaint alleged the facility was not cleaning resident (R1) after being fed. On 05/24/2021 and 05/27/2021 LPA interviewed Administrator and three (3) of three (3) facility staff who stated R1 was cleaned frequently during meals and after meals. Staff stated R1 would need to be wiped down during and after meals. Administrator stated that every three (3) weeks R1's bed was scrubbed down as well. On 05/26/2021 the National Director of Licensing for Bristol Hospice stated the nurse's notes did not indicate R1 was not being properly cleaned after feeding. LPA was unable to make contact with hospice nurse due to them leaving the agency. LPA attempted to contact R1's family member on 05/24/2021, 05/27/2021 and 05/28/2021 but was unable to make contact for an interview. No further evidence could be provided.

Due to the above information, CCL finds the allegations listed above to be UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated.

Exit interview conducted, copy of report and appeal rights provided.

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021

LIC9099 (FAS) - (06/04)

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