347001498-12-28-2023-59-AS-MSEY-D3CPV2-20240314113819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 12/28/2023
Date Signed: 12/28/2023 04:45:07 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
12/26/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20231226105149

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:	12/28/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Toni Jones, Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Licensee did not ensure there are qualified night staff able to administer medications to residents in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to open a complaint received on 12/26/23. LPA met with Toni Jones, Administrator, and explained purpose of inspection.

During today's inspection, LPA interviewed the Administrator, Resident Care Coordinator, (1) caregiver, (1) Med-Tech staff,and (R1's) family member. LPA also obtained copies of recent text messages between resident (R1's) family member and the Administrator regarding the above allegation.

The results of the investigation are as follows:

The allegation states the facility did not have a qualified staff to dispense medication to residents at night and the administrator had to be called to come in to dispense pain medication.

cont on 9099C-1...

Substantiated

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: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

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-20231226105149

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: 12/28/2023

NARRATIVE

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9099C-1... (R1's) family member stated to LPA on 12/28/23 that she arrived at the facility on Sunday, 12/24/23 at approximately 9:30 pm to visit (R1). This family member stated she heard (R1) screaming upon her arrival to the community and was informed by (R1) that her neck hurt, and she needed pain medication. This family member stated staff then contacted the Resident Care Coordinator by phone at least twice, between 9:30-10:00 pm, and when the RCC did not answer the call, she reached out to the Administrator, by text message. Resident Care Coordinator showed LPA her missed phone calls from 12/24/23. At 11:06 pm, she received a missed call from the Administrator; at 11:11 pm, she received a missed call from (R1's) family member; and at 11:12 pm and 11:13 pm, she received missed calls (2) from care staff, Gertrude. RCC stated she responded at 11:15 pm to staff on duty, but did not receive a response so immediately followed up with the Administrator.

LPA reviewed text messages received by the Administrator, at 10:54 pm on 12/24/23, where (R1's) family member states she just arrived at the facility and (R1) indicated "she's hurting all over...and she's not able to sleep... needs Tylenol and maybe another Trazadone". The Administrator stated to LPA she had just missed (R1's) call that night and when she went to check the missed call, she saw the text messages received just prior to the call. LPA reviewed the text message sent from the Administrator to (R1's) family indicating she or the RCC would be at the facility shortly to administer Tylenol since there was an error with the order for Trazadone. Administrator stated to LPA she arrived at the facility at 11:50 pm that night and administered Tylenol to (R1).

The Administrator confirmed that following recent changes to the medication room, there was not a Med-Tech staff or other staff on duty, on 12/24/23, at 10:54 pm, who was able to administer the pain medication to (R1) when requested, until she arrived at the community at approximately 11:50 pm, or an hour later.

Based on information obtained, LPA finds the allegation to be SUBSTANTIATED- finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) citation is issued on the 9099-D page.

Exit interview with the Resident Care Coordinator. This finding was discussed with the Administrator earlier during the inspection. Copy of report provided to the facility.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20231226105149

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: 12/28/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type A 12/29/2023 Section Cited CCR 87413(a)(1)	1 2 3 4 5 6 7	87413 Personnel - Operations. (a) In each facility: (1) When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator agree to immediately schedule a Med-Tech staff or other staff that is trained to administer medications, for all shifts, effective 12/28/23. Administrator confirmed with RCC on 12/28/23 that staff (S1) is scheduled for PM and NOC shift from 12/28/23-12/29/23 and other NOC shifts. Additionally, another Med-Tech was recently hired to work NOC shifts if needed.
	8 9 10 11 12 13 14	Based on interviews conducted and text messages reviewed, the Licensee did not ensure that there was a Med-Tech staff or other staff on duty on 12/24/23, from approximately 10:54 pm to 11:50 pm, that was able to administer PRN medication for pain to (R1), which posed an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	Documentation of Med-Tech schedule from 12/28/23 - 1/31/24 to be provided to the Department by 12/29/23. Admin will cover 1/27/24 and RCC will cover 1/19/24.
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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 Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

LIC9099 (FAS) - (06/04)

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