347001498-9-26-2023-59-AS-MSEY-CW3SY2-20230927141647

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 09/26/2023
Date Signed: 09/26/2023 04:47:24 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
09/21/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230921164843

FACILITY NAME:	CITRUS HEIGHTS TERRACE		FACILITY NUMBER:	347001498
ADMINISTRATOR:	TONI JONES		FACILITY TYPE:	740
ADDRESS:	7952 OLD AUBURN ROAD		TELEPHONE:	(916) 727-4400
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	45	CENSUS: 43	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Toni Jones, Administrator		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not maintain facility clean and sanitary at all times
Staff do not assist resident with grooming

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to open and close a complaint received anonymously on-line on 09/26/23. LPA met with Toni Jones, Administrator, and explained purpose of inspection.

During today's inspection, LPA discussed the allegations with the Administrator and (2) staff. LPA also inspected the shared room that is referenced in the complaint with the Administrator and attempted to speak to both residents who occupy it.

The results of the investigation are as follows:

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: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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-20230921164843

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: 09/26/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

9099C-1... Allegation: Staff do not maintain facility clean and sanitary at all times.
Complaint alleges that resident's family member visited the resident and observed the resident's mattress to be soiled with urine and to contain urine stains. The complaint does not indicate which resident in the shared room this allegation pertains to.

LPA and Administrator inspected the shared room referenced in the complaint, including the bathroom. LPA observed each resident's bed to be made and the bedding, and protective coverings (Chux) to be clean and dry. Additionally, LPA did not observe any incontinent odors in the room or near the beds.

One staff who works on the "am" shift, stated that when (R1's) family visits, (R1's) bed is made and no complaints have been made regarding the allegation. This staff stated that (R1) will tell staff when she needs to use the bathroom. The same staff stated that both residents are "heavy whetters" and (R2) had (2) outside care providers visit today and there were no complaints made to staff about (R2's) bedding needing to be changed.

A second staff, who works on the "pm" shift stated he has never seen either resident's bed soiled and needing to be laundered and confirmed caregivers will assist housekeeping with changing resident's linens.

Due to their Dementia diagnosis, both residents were unable to communicate to LPA if staff changes their linens timely. The Ombudsman also recently investigated this allegation and did not find any evidence.

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.

Allegation: Staff do not assist resident with grooming. Complaint alleges that resident's teeth were observed to be layered with food, and the resident's blouse had food on it. The complaint does not indicate which resident in the shared room this allegation pertains to.

LPA observed resident (R1) to be wearing clean clothes. Administrator and LPA were unable to get (R1) to smile fully to show if her teeth were clean, but no food pieces were seen when (R1) was talking. (R1) was upset at the time of the inspection.
cont on 9099C-2...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 59-AS-20230921164843

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: 09/26/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

9099C-2.. LPA attempted to speak to resident (R2) who was sitting in a wheelchair in the dining room. (R2) was not able to engage in conversation with LPA and did not show her teeth when LPA was observing her. LPA did observe what appeared to be a small area on the lower area of her T-shirt to be stained with food possibly; however her jacket was observed to be clean and free from any food spots.

Two staff stated that (R1) is a relatively neat eater and staff will usually use a bib to help keep her clothes clean. One staff stated that (R1) will let staff know if something is bothering her and will generally allow staff to brush her teeth. A second staff stated (R1) does not usually get food stuck in her teeth.

Both staff interviewed stated that (R2) eats pureed food only and uses a bib since she is a messy eater. One staff indicated that (R2) is able to eat independently. Both staff confirmed that (R2) does not get food stuck in her teeth but occasionally gets food spilled on her clothes, especially her shoes. One staff indicated that it can be challenging to brush (R2's) teeth, so staff will use a tooth sponge.

Due to their Dementia diagnosis, both residents were unable to communicate to LPA if staff changes their clothes, when soiled, and brushes their teeth when needed. The Ombudsman also recently investigated this allegation and did not find any evidence.

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 the Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3