347001498-10-24-2023-59-AS-MSEY-CWXNQ9-20231025103933

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 10/24/2023
Date Signed: 10/24/2023 05:21:30 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
07/26/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230726152403

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:	10/24/2023
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Toni Jones, Administrator		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

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Staff are mishandling resident's medications.
Staff does not ensure resident is administered medications as prescribed.
Staff leaves resident's mattress soiled.
Resident's room is malodorous.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to close a complaint received on-line and anonymously on 07/26/23. LPA met with Toni Jones, Administrator, and explained purpose of inspection.

During the investigation, LPA discussed the allegations with the Administrator, RCC and a Med-Tech staff and toured the facility on several different occasions. LPA went into multiple resident rooms, including the room referenced in the complaint, and also checked several residents's bedding to see if it was soiled. The results are as follows:

Allegation: Staff are mishandling resident's medications. The complaint alleges there were medications seen in resident’s room (shared by R1 and R2) when visiting one of the residents.

*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: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

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 4

Control Number 59-AS-20230726152403

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: 10/24/2023

NARRATIVE

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9099C-1...The room referenced in the complaint is occupied by (2) residents. LPA toured the room on 7/31/23, 8/22/23, 9/7/23 and 9/26/23 and did not observe any medications to be left out in the room.

The complaint does not indicate which resident this allegation pertains to nor were there any specifics provided as to the day of the week, time of day, or name of medication.

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

Allegation: Staff does not ensure resident is administered medications as prescribed.

Complaint alleges that resident’s family member monitors resident’s medications and facility staff did not notify family member that the resident has been out of her meds for a couple of weeks, and resident'’s doctor was not notified either.

The Department received additional anonymous on-line complaint on 7/27/23 alleging the same information. There were again no specifics provided.

The Administrator, RCC and a Med-Tech (S2) stated on 10/24/23 there have been no problems with (R2) receiving her medications and indicated she has been on hospice for the majority of the time she has been a resident at the facility.

The current Administrator and the RCC stated there was only a problem with (R1) receiving medications on/around March 2023 when the dispensing pharmacy sent medications to (R1's) prior residence. This allegation was investigated previously for (R1).

There were no specifics provided as to which resident in the shared room the allegations pertain to. Also, the day of the week, time of day, and name of medication were not mentioned.

Based on the lack of specific 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.

cont on 9099-C-2...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 59-AS-20230726152403

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: 10/24/2023

NARRATIVE

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9099C-3...Allegation: Staff leaves resident's mattress soiled. Complaint alleges that when visiting resident’s room, resident’s mattress is soiled with the urine, the mattress was even wet to the touch.

On 7/27/23,the Ombudsman inspected the shared room and did not observe either resident's mattress to be soiled. On 7/31/23, LPA inspected both resident mattresses in the room and observed them to be dry. LPA observed layers on the plastic protector- 1- cloth, 2- sheet, 3- cotton chuck, 4- disposable chuck. (S1) indicated the caregivers have to help with changing sheets as housekeeping gets busy. (S1) confirmed that caregivers will make beds and replace any soiled sheets "right away".

(S1) stated (R1's) daughter picks up her laundry every other day and wants to wash (R1's) sheets even if they are soiled.-(S1) commented that maybe once/week they are soiled and (R1's) daughter has never asked them not to separate the soiled sheets, and she has specifically told staff "don't wash the sheets" since the dryer shrinks them.

Staff (S1) stated (R2) who also occupies the room is incontinent like 89% of the residents. (S1) stated all incontinent residents have both a cotton and disposable chuck on the sheets. 11% of residents can walk to the bathroom. LPA observed (R2’s) mattress and bedding to be clean and dry. LPA also toured (8) other resident rooms with care staff (S1) and observed all resident beds to have dry, clean sheets on them. LPA toured the shared room again on 8/22/23 with the Administrator. LPA observed (5) layers of protection on the top mattress and then a top sheet and (2) blankets. LPA observed all layers to be dry and appear to be freshly laundered free of any incontinent odors. LPA observed roommates' bed to also be dry in all layers.

On 9/7/23, LPA confirmed with a housekeeping staff that she and caregivers change resident sheets, and there are not any female residents that stand out as having significant incontinent issues. This same information was confirmed with a second care giving staff also on 9/7/23. LPA toured the room again, on 9/26/23, with the Administrator. Both residents were outside of their room in the common areas during the inspection. LPA pulled the blankets back to observe the bedding on each resident's bed. LPA observed all bedding, including Chux pads, to be clean and dry and did not observe any urine stains.

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

cont on 90099C-... 4

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20230726152403

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: 10/24/2023

NARRATIVE

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9099C-4... Allegation: Resident's room is malodorous. Complaint alleges that when visiting resident’s room, resident’s room smelled like urine again.

On 7/27/23,the Ombudsman inspected the shared room and did not observe any smell of urine.

On 7/31/23, LPA did not observe any incontinent odors in the shared room for R1 and R2. LPA also toured (8) other resident rooms with care staff (S1) and did not observe any significant incontinent odors in the rooms toured.

LPA toured the shared room again on 8/22/23 with the Administrator. LPA observed the room to be neat, bed made and without any incontinent odors and to contain lots of incontinent supplies in the bathroom. There were no incontinent odors present.

On 9/7/23, LPA toured (3) additional resident rooms that were observed to be clean, without any significant incontinent odors, and the trash was emptied. LPA also observed residents’ beds to be made.

On 9/26/23, LPA observed the shared room and bathroom to be clean and odor free.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC9099 (FAS) - (06/04)

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