347001498-11-9-2023-59-AS-MSEY-CXLQ66-20231115105258

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 11/09/2023
Date Signed: 11/09/2023 04:33:07 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
11/06/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20231106104515

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: 44	DATE:	11/09/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Toni Jones, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not ensure resident's medication was ordered in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to open a complaint received on-line anonymously on 11/6/23. LPA met with Toni Jones, Administrator, and explained purpose of inspection.

During today's inspection, LPA discussed the allegation with the Administrator, Resident Care Coordinator (RCC) and (1) Med-Tech staff. LPA reviewed Medication Administration Record (MAR) documentation for resident (R1) who is referenced in the complaint.

The results are as follows:
The complaint alleges that a family member of (R1) recently visited (R1) and asked staff the reason why she was not contacted when (R1's) medications ran out.

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: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

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-20231106104515

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: 11/09/2023

NARRATIVE

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9099C-1. Administrator stated that (R1) resides in a private room and her family has not visited recently, as one family member lives out of state and the other one lives outside of the local area. Both the Administrator and RCC confirmed there have not been any concerns recently brought to their attention from (R1's) family members, including with medications, and the Administrator stated she and (R1's) daughter discuss (R1's) care regularly.

LPA reviewed MAR documentation for October 2023 and for November 2023 and observed there to be (8) medications listed. LPA observed documentation to be complete on the MAR and Centrally Stored Medication Record (LIC622), with the # of refills listed for each medication.

A Med-Tech staff confirmed that she and other Med-Tech staff will call the pharmacy to request a refill and note it on the bubble pack as well as on the Fax transmittal. LPA observed notations on a bubble pack(s) that a refill had been ordered.

Both the Administrator and Ombudsman were told by (R1's) daughter that neither she or the other family member filed this complaint. The Ombudsman spoke to (R1's) daughter on 11/8/23 who indicated she has no current concerns with medication administration but did in July 2023. The family member reported that all issues have been resolved, her mother receives appropriate care and all medications are ordered timely. Currently, the facility is participating in medication audits with multiple outside companies and has increased medication checks internally.

Also mentioned in the complaint was that (R1) was not allowed to have a refrigerator. The Ombudsman and Administrator indicated that (R1) requested to have the refrigerator removed from her room a few months back due to the noise the motor made.

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.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC9099 (FAS) - (06/04)

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