347001498-8-9-2023-59-AS-MSEY-CUQM7N-20230815092148

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 08/09/2023
Date Signed: 08/09/2023 05:24:49 PM

Substantiated

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
08/07/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230807090749

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: 42	DATE:	08/09/2023
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Ashley Stahl, Resident Care Coordinator		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

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Staff are mismanaging resident's medications.

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 Ashika Bennanon, Med-Tech, who stepped out of the staff meeting taking place and directed LPA to an empty office area. LPA later met with Ashley Stahl, Resident Care Coordinator (RCC) and explained purpose of inspection. LPA observed a resident (R2) being taken by a non-emergency ambulance provider to the hospital for medical attention. Also occuring during today's inspection was the fire department arriving due to the smell of smoke coming from inside resident walls in two rooms. The source of the smoke was determined to be related to a repair made by an HVAC company yesterday. Residents were moved to the other side of the building and no one was injured.

During today's inspection, LPA discussed then allegation with RCC and (3) Med-Tech staff. LPA also reviewed medication documentation pertaining to resident (R1).

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: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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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Control Number 59-AS-20230807090749

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: 08/09/2023

NARRATIVE

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9099C-1...LPA reviewed a letter that was faxed to the community on 7/28/23 requesting changes be made following resident's medical evaluation that day:

Discontinue Medication, Prozac (Fluoxetine) 10 mg
Discontinue Risperidone (scheduled and PRN doses)
Start Olanzapine 2.5 mg po qhs for 3 days , then increase to 2.5 mg, po bid on 7/31/23d
Continue Lorazepam, as PRN, and Melatonin and Donepezil at current doses

LPA reviewed a Medication list faxed to the facility on 8/8/23 (9:23 am) noted as "New and Updated list as of 4 pm- 8/7/23". Med-Tech staff indicated that medication changes hadn't been inputted into the system to be reflected on the MAR as of 8/7/23. Resident's Nurse Practitioner came out to the facility on 8/7/23 to review the medications as she was upset the updates to resident's medications had not been implemented on the MAR on/around 7/28/23. Specifically, changes to resident's medications were not entered into the system on/around 7/28/23.

MAR records for August 2023 reflect (4) medications discontinued on 8/8/2023 and (3) medications added effective 8/8/2023, and show a total of (10) medications listed on the MAR, which agrees with the medication orders. Discontinued medications as follows: Fluoxetine 10 mg tab; Acetaminophen/Hydrocodone 325-5 mg tablet; Ibuprofen 600 mg tablet; and Lorazepam 0.5 mg tablet. Medications added: Multivitamin with minerals; PRN Mineral Oil; and Tea Tree Oil on toenails daily.

Med-Tech staff indicated that resident's nurse practitioner was provided with a signed/updated MAR for August on 8/7/23, as requested.

Based on information obtained, LPA finds the allegation to be SUBSTANTIATED- 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) citation is issued on the 9099-D 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: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20230807090749

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/09/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/10/2023 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator agree to submit a training plan to the Department by 8/10/23 regarding medication training, to include timely entering of medication orders in the system and correct documentation/initialing on the MAR.
	8 9 10 11 12 13 14	Based on documentation reviewed and interviews conducted, the Licensee did not ensure that medications changes for resident (R1)faxed to the facility on 7/28/23 were updated timely in the system to be reflected on the MAR, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	Documentation of completed staff training to be submited to the Department by 8/23/23 to include agenda and attendees.
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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 Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC9099 (FAS) - (06/04)

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