347001498-11-20-2023-59-AS-MSEY-CXTNTG-20231122094444

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 11/20/2023
Date Signed: 11/20/2023 04:52:16 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
11/15/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20231115161701

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:	11/20/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Ashley Stahl, Resident Care Coordinator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff are not ensuring that the facility is free of pests
Staff are mishandling residents’ medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to open a complaint received on-line anonymously on 11/15/23. LPA met with Ashley Stahl, Resident Care Coordinator (RCC) and explained purpose of inspection. Toni Jones, Administrator, was out of the facility during today's inspection. LPA observed several residents in the common areas during today's inspection.

During today's inspection, LPA interviewed RCC and a Med-Tech staff and reviewed PRN medication for (3) residents, (R2, R3 and R4), as referenced in the complaint. LPA also toured the the room for resident (R1) who is also referenced in the complaint. LPA also observed and attempted to speak to several other residents who allegedly reported a rash and had complaints of itching.

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: 11/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

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-20231115161701

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: 11/20/2023

NARRATIVE

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9099C-1... Allegation: Staff are not ensuring that the facility is free of pests. The complaint alleges that resident (R1) has roaches in her room. There is no day/time reference provided with the allegation.

LPA and a Med-Tech staff (S1) toured (R1)'s room on 11/20/23. LPA observed (R1) to be sitting in a wheelchair and not able to speak clearly. LPA observed the carpet to be clean and did not see any roaches or other bugs in the room on the floor. LPA and the Med-Tech opened several dresser drawers in (R1)'s room, and there were no roaches observed. The Med-Tech stated that (R1) used to have a mini refrigerator in the room and would also eat near the refrigerator, and if there were any bugs in the room, they would be in the area where the refrigerator was. The Med-Tech staff stated she has worked all shifts and has not seen any roaches, or bugs, in (R1)'s room. RCC stated a family member has been moving resident's items from the room in preparation for a move and did not mention any sign of bugs.

The complaint also alleges that residents (R1), (R4), (R5), (R6), (R7), (R8), (R9) and (R10), who reside
in (7) different rooms, have rashes and complaints of itching. LPA reviewed the resident rooms provided with the RCC and Med-Tech (S1). The RCC stated that none of these residents have complained of a rash or itching in recent months and none of the residents had scabies a few months back. The Med-Tech staff stated that (R5) has not complained of a rash, and (R6) is under hospice care. The same staff stated (R4) uses skin creme on a regular basis as well as (R7) and (R1), (R8) and (R10) have had no rash. Resident (R9) who used to reside in a room that is currently vacant did not have a rash prior to passing.

LPA was able to interview (R8) who indicated he has had no itching or rashes since moving to the community. LPA observed (R1) and (R4) in their rooms and did not see a visible rash. The other residents were not in their rooms at the time of the inspection and not able to be interviewed/observed.

The Department previously investigated a similar allegation on 9/7/23 and had conducted a tour in the kitchen area, laundry area, staff break room and (2) resident dining rooms, including underneath the kitchen sinks, at that time. In all areas toured, there were no roaches or other bugs observed. Staff interviewed stated that the only roach seen was one trying to enter the resident dining room from the outside, and this was determined to be an isolated incident. LPA was provided with a invoice for service provided on 7/29/23, from an outside pest control company and confirmed that the facility receives regular scheduled pest control treatments.

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.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20231115161701

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: 11/20/2023

NARRATIVE

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9099C-2.. Allegation: Staff are mishandling residents’ medication. Complaint alleges that (R2, R3 and R4)) do not have a current supply of PRN medication for pain and agitation/anxiety. Complaint also alleges that there is loose medication in the common areas.

LPA reviewed the PRN binder with documentation of the PRN and the Medication Administration Record (MAR) for November 2023. LPA and Med-Tech, (S1) reviewed PRN medications for (R2),(R3) and (R4), specifically, as follows:

(R2)- documentation shows (R2) takes (3) medications for pain or agitation/anxiety- Acetaminophen, Ibuprofen and Lorazepam. LPA observed a bubble pack of Tylenol that was filled on 10/2/23 and had (25) of (30) tablets remaining. There were no tablets administered in November 2023. The facility received a discontinuance order for Ibuprofen and Lorazepam effective January 2023. RCC to update the PRN list and MAR.

(R3) - documentation shows (R3) takes (1) medication for pain or agitation/anxiety- Trazadone 50 mg. LPA observed the bottle for the scheduled order and a bubble pack for the PRN. Resident has not requested or been administered any PRN for November 2023.

(R4) -documentation shows (R4) takes (3) medications for pain or agitation/anxiety- Acetaminophen, Lorazepam and Morphine. (R4) is under hospice care. LPA observed a separate bottle for each of these medications on hand. November 2023 MAR shows there was no PRN medication administered for pain and or agitation/anxiety.

LPA toured the interior of the facility and did not observe any loose medication in the common areas.

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 emailed to the RCC.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

LIC9099 (FAS) - (06/04)

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