347001498-7-13-2023-59-AS-MSEY-CTTMWM-20230717095832

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 07/13/2023
Date Signed: 07/13/2023 04:08:22 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/10/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230710094256

FACILITY NAME:	CITRUS HEIGHTS TERRACE		FACILITY NUMBER:	347001498
ADMINISTRATOR:	EDITHA MCCULLOUGH		FACILITY TYPE:	740
ADDRESS:	7952 OLD AUBURN ROAD		TELEPHONE:	(916) 727-4400
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	45	CENSUS: 45	DATE:	07/13/2023
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Editha McCullough, Interim Administrator		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Residents in care sustained unexplained bruises

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to open a complaint investigation for the above allegation. LPA met with Editha McCullough, Interim Administrator, and explained purpose of inspection. LPA also observed an Ombudsman staff to be present at the facility at the start of the inspection.

During today's inspection, LPA interviewed Administrator, Resident Care Coordinator (RCC), (1) Med-Tech staff. Ombudsman was present when (2) residents were observed and attempted to be interviewed regarding recent bruising they sustained from unwitnessed falls. LPA reviewed resident files and incident reports submitted for each resident following an unwitnessed fall. The results of the investigation are as follows:

The Department received an anonymous complaint on 7/10/23 alleging "there are two residents that have really big bruises on their face and one resident that got hurt". There were no details provided as to resident names, dates of injuries, or staff names or witnesses.

The Department receivesd (2) incident reports on 7/11/23 for residents (R1 and R2) reporting bruises that were observed on each resident.
**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: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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 59-AS-20230710094256

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CITRUS HEIGHTS TERRACE	FACILITY NUMBER: 347001498
	VISIT DATE: 07/13/2023

NARRATIVE

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9099C(1).The incident report for R1 reports that resident had an unwitnessed fall on 7/6/23 (6:30 pm) in the hallway and sustained a large lump on her head and left side of her face. Resident was sent out to ER for further medical evaluation and returned the same day. Resident was placed on 48 hours alert charting. Care Plan was last updated 2/2/23 and notes resident needs escorts to meals and activities. Physician's report, dated 10/12/22, indicates resident is ambulatory but is a fall risk. Resident does not require 1:1 supervision.

Interview with Administrator confirmed that resident was sent out for medical attention immediately following the unwitnessed fall. Interview with Med-Tech staff (S1) revealed S1 was not working on 7/6/23 (6:30 pm) when resident R1 had an unwitnessed fall. S1 stated that she/staff has been working with resident's medical provider regarding resident's medications, which have been "cut back about 35%". S1 indicated that resident won't sit in a wheelchair and tries to push the chair instead and confirmed that R1 has not had any subsequent falls and gets agitated with staff easily. LPA and Ombudsman observed R1 on 7/13/23 in her room at the community. Resident was standing up behind a wheelchair as if she was going to push it. Resident initially stated she was in pain but then said she was not and was not able to provide any details as to how the bruising occurred.

The incident report for resident (R2) reports that resident was sent out to the ER on 7/9/23 (8:30 pm) after being evaluated by a hospice nurse and physician, due to bruising and swollen lips and eyes. Staff (S1) stated she was working at the facility on 7/9/23 (Sunday) when resident was sent out to the ER, explaining resident had a prior unwitnessed fall on 7/6/23, in the hallway and sustained bruising on her face/lip area. S1 stated she called hospice on 7/9/23 due to the bruises appearing worse than in previous days. S1 stated resident returned to the facility on 7/10/23, in the afternoon, asserting "R1 falls quite often" and she/staff and resident's son have been working with hospice to adjust resident's medications so that medications causing drowsiness are only taken during the evening hours. S1 confirmed that resident has not fallen since Monday, 7/10/23, prior to the medication changes made on Tuesday, 7/11/23.

Both the Administrator and S1 confirmed there have been no other residents who have sustained any bruising in recent weeks other than residents R1 and R2, and they were both due to unwitnesed falls.

Based on information obtained, LPA finds the 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 to Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/10/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230710094256

FACILITY NAME:	CITRUS HEIGHTS TERRACE		FACILITY NUMBER:	347001498
ADMINISTRATOR:	EDITHA MCCULLOUGH		FACILITY TYPE:	740
ADDRESS:	7952 OLD AUBURN ROAD		TELEPHONE:	(916) 727-4400
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	45	CENSUS:	DATE:	07/13/2023
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Editha McCullough, Interim Administrator		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Facility does not have adequate staffing

INVESTIGATION FINDINGS:

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During today's inspection, LPA interviewed Administrator and Resident Care Coordinator (RCC) and reviewed July 2023 staffing schedules for all employee shifts. LPA also observed staffing levels. The results of the investigation are as follows:

There were no specific details provided pertaining to the allegation of insufficient staffing. RCC stated she has increased staffing levels across all (3) shifts in the last two weeks and the new staffing levels are: (3-4) caregivers and (1) Med-Tech on the "am" and "pm" shifts, and (2-3) caregivers and (1) Med-Tech on the NOC shift. RCC confirmed that if there are call-outs, managers will fill in. LPA reviewed the July 2023 staffing schedules provided today. LPA observed (3-4) care staff and (1) Med-Tech scheduled on the "am" and "pm" shifts and (2-3) staff scheduled on the NOC shift. Administrator explained that since only PRN medications are given during the NOC shift, the Med-Tech scheduled will also work as a care staff. LPA observed agency staff are scheduled as well, when needed, and observed multiple care staff, housekeeping, Maintenance Director, and Med-Tech staff.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without reasonable basis.

Exit interview. Copy of report provided to Administrator.

Unfounded

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: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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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