<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 01/30/2024
Date Signed: 01/30/2024 05:29:14 PM

Substantiated


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
01/02/2024 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20240102161217
FACILITY NAME:CITRUS HEIGHTS TERRACEFACILITY NUMBER:
347001498
ADMINISTRATOR:TONI JONESFACILITY TYPE:
740
ADDRESS:7952 OLD AUBURN ROADTELEPHONE:
(916) 727-4400
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:45CENSUS: 44DATE:
01/30/2024
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Toni Jones, Administrator TIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Medication mismanagement.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA) Sabrina Calzada and Melissa Parks arrived unannounced to close a complaint received on 1/2/2024. LPA met with Toni Jones, Administrator, and explained purpose of inspection.

During the investigation, LPA interviewed multiple staff and a family member of resident (R1). LPA also reviewed documentation, related to resident (R1), including emails, medication documentation, charting notes and other documentation.

The results of the investigation are as follows:

cont on 9099C-1...


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
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-20240102161217
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: 01/30/2024
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: Medication mismanagement. The complaint alleges that resident (R1) ran out of medications on (2) occasions.

Resident’s (R1) family member stated the first time (R1) missed her medications was after the initial (30) day supply of Olanzapine 2.5 mg, taken at bedtime, was started on 7/26/23. The MAR and LIC622 document this prescription was filled and started on 7/26/23, with no automatic refills. The Med-Tech/Nurse communication log also documents that medications were received on 7/26/23, and Olanzapine was logged and stored as well as other medications. MAR documentation for July and August 2023 does not reflect the medication was administered consistently and shows (3) days/dosages were missed in July and multiple days/dosages were missed in August.

If the medication was started on 7/26/23, it should have run through 8/24/23. The next prescription, noted as a (3-day) emergency supply, was not filled until 8/27/23. Resident’s responsible person stated that on Tuesday, 8/29/23- there was a medical follow up for this anti-psychotic medication that was prescribed for "auditory hallucinations". The LIC622 documents that a (5) day prescription was filled on 8/29/23, but not started on 9/6/23.

Staff interviews indicated that they would reach out to the resident’s responsible person and leave voice messages regarding a medication needing to be refilled and the responsible person did not return the call. The RCC stated that when (R1) first moved in, she had no medical insurance and "everything was still out of state". RCC stated that there was only "one time" when (R1) missed medications, stating she believes the medication was "Olanzapine". The Administrator stated the Med-Tech would call for refills and then call the family member to pick them up, and she was aware of what was needed" for the refills and agreed to pick up the meds when (R1) moved in.


Resident’s family member mentioned that a medication ran out for resident again, on Friday, 10/13/23, and she was just notified by staff, and the last dosage to be administered had been poured for the evening of 10/13/23. LIC622 documents that a 90- day supply of scheduled Levothyroxine .88mg, was filled on 10/13/23 and started on 10/14/23. MAR shows resident did not miss any dosages of this medication taken in the morning in October.

Exit interview. Copy of report and appeal rights provided.

cont on 9099C-2...

SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
01/02/2024 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20240102161217

FACILITY NAME:CITRUS HEIGHTS TERRACEFACILITY NUMBER:
347001498
ADMINISTRATOR:TONI JONESFACILITY TYPE:
740
ADDRESS:7952 OLD AUBURN ROADTELEPHONE:
(916) 727-4400
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:45CENSUS: 44DATE:
01/30/2024
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Toni Jones, Administrator TIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is malodorous.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Allegation: Facility is malodorous. The complaint alleges that the lobby area has strong incontinent odors of urine which are carried throughout the building. This was observed at different times of the day.

The resutls of the investigation are as follows:

LPA Calzada conducted numerous inspections in 2023 and did not observe any strong, consistent incontinent odors to be present during any visit. LPA Parks also visited the community on a few occasions and did not observe any strong incontinent odors. The Administrator stated certain resident rooms are cleaned regularly when the resident has greater incontinent concerns.

Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview. Copy of report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 59-AS-20240102161217
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/01/2024
Section Cited
CCR
87465(a)(4)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee/Administrator will inquire if they can contract with a local pharamcy regarding obtaining a private pay emergency supply, if the family member doesn't pick up the medications timely.
8
9
10
11
12
13
14
Based on documentation reviewed and interviews conducted, the Licensee did not ensure that resident (R1) did not miss a dosage of Olanzapine on/around August 24-25, 2023, which posed an immediate health and safety risk to residents in care.
8
9
10
11
12
13
14
All Med-Tech staff were re-trained or in the process of being retrained, on thorough documentation on the MAR and LIC622 and documenting attempts to contact family members when a refill is needed.

Documentation to be provided by 2/1/24 for training and by 2/8/24 for the local pharmacy.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4