347001498-8-22-2023-59-AS-MSEY-CUZLSL-20230824090055

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 08/22/2023
Date Signed: 08/22/2023 05:11:16 PM

Unfounded

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
08/17/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230817142551

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: 44	DATE:	08/22/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Toni Jones, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are not meeting resident's hygiene needs resulting in resident not staying dry.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to open a complaint investigation received anonymously on 8/18/23. LPA met with Toni Jones, Administrator, and explained purpose of inspection.

LPA discussed the allegation with the Administrator, RCC and (2) caregivers. LPA reviewed documentation from resident (R1) who is the subject of the complaint. The results of the investigation are as follows:

Complaint alleges that resident is having urine infections due to not staying dry.

Administrator confirmed that there is no record of resident having a recent urinary tract infection (UTI). Both the RCC and a Med-Tech staff stated that R1 had a UTI several months ago, and the only recent medical intervention has been bladder surgery and follow up care for removing a catheter.
cont on 9099C-1...

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: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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-20230817142551

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: 08/22/2023

NARRATIVE

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9099C-1...LPA and Administrator observed R1 to be resting in her room in her wheelchair. LPA observed resident's bed to be made and the linens and chucks to be dry underneath. LPA observed a supply of incontinent products also in the room and attached bathroom. Administrator assisted resident in transferring to her bed to take a nap. LPA did not note any incontinent odors to be present in the room.

Interview with a caregiver staff revealed that she sometimes assists resident with incontinent care, resident cooperates well with staff, and staff will check on resident at least every 2 hours. This caregiver stated that resident has not had any urinary tract infections.

A Med-Tech staff indicated that resident had surgery for bladder cancer and is currently on hospice. Staff stated that resident has not had a UTI but ripped out a catheter around May 2023 and had some blood spotting following surgery in May, one time, and so hospice was called. Staff stated that resident is very conscious of when she needs to use the bathroom and will ask staff for assistance, even though she is incontinent.

LPA reviewed resident's facility file and hospice binder and noted resident began hospice on 5/11/23.

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

The following Technical Advisory Note is issued related to a review of resident's file.

The complaint also alleges that resident ran out of two medications. Interview with a lead Med-Tech revealed that resident's hospice provider will visit once or twice weekly and takes care of all medication orders, every 7 days. Medication refills are also delivered to the facility. LPA reviewed MAR for August and observed all ordered medications were received and administered timely.

Exit interview. Copy of report provided to Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

LIC9099 (FAS) - (06/04)

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