347001498-6-13-2024-59-AS-MSEY-D6BLRU-20240617085939

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 06/13/2024
Date Signed: 06/13/2024 05:00:27 PM

Unsubstantiated

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
03/15/2024 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20240315162450

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:	06/13/2024
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Toni Jones, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not notify responsible party of resident's change of diet.
Staff did not provide reporting agency an itemized list of fees.
Facility did not notify resident's responsible person of an increase in monthly rent rates.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver complaint findings to an for a complaint received on 03/15/24. LPA initially met with Editha McCullough, Assistant Administrator, and shortly thereafter met with Toni Jones, Administrator. LPA stated the reason for today's inspection. There are currently (45) residents, (9) of whom are under hospice care, and (1) resident is currently in the hospital. Also present during today's inspection was (R1's) family member who LPA and Administrator spoke with.

During the investigation, LPA interviewed the Administrator, Resident Care Coordinator (RCC), (2) culinary staff, Ombudsman, social worker from an outside agency, hospice social worker, and resident (R1’s) family member. LPA reviewed multiple e-mails, hospice notes, physician's orders, and the physician's report and care plan for (R1).

The results of the investigation are as follows:

*cont on 9099C-1...

Unsubstantiated

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: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

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-20240315162450

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: 06/13/2024

NARRATIVE

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9099C-1.. Allegation: Staff did not notify responsible party of resident's change of diet. The complaint states that resident’s family member visited the facility in early March 2024 and found out (R1) was put on a liquid diet that she was not made aware of.

Resident (R1's) physician's report, dated 2/2/2023, notes resident has a special diet of “mechanical soft finger foods”. The Administrator stated that (R1's) physician signed off on a pureed diet on 1/26/24, after (R1) "got a small piece of soap in her mouth from another resident's room, which caused her lip to swell". LPA observed the hospice order on 1/4/24 for one time dose of Diphenhydramine 25 mg for lip swelling (2 tablets). LPA reviewed a hospice order, written on 1/25/24, to “downgrade (R1's) diet to pureed diet”, and a subsequent order, written on 3/7/24, to “upgrade (R1's) diet to soft mechanical”.

The Administrator stated (R1) was placed back on a soft mechanical diet on/around March 2024. (2) culinary staff, who have worked at the community for many years, stated that (R1) has always had a mechanical soft diet but was changed to a pureed diet, for a short time, but has been changed back to mechanical soft diet. LPA observed a posted notice in the kitchen that shows (R1) has a "Mechanical Soft Diet". One culinary staff stated the list is updated regularly when there are new residents or a resident's diet has changed. RCC stated that she told the hospice nurse (R1) prefers finger foods, but the nurse did not agree to change (R1) from a pureed back to a mechanical soft until March 2024, stating "the nurse thought (R1) was eating well on the pureed diet"; however, (R1) would still take other resident's mechanical soft food from their plates. On 6/13/24, LPA observed (R1) to be able to eat soft food for lunch, using her fingers.

Both the Administrator and RCC stated the hospice company would have called (R1's) responsible person in Jan and March 2024. when the orders were written. LPA confirmed with a hospice social worker on 6/13/24 that it is documented in their notes that on 1/4/24 and 1/25/24, hospice had "updated (R1's) daughter". The nurse confirmed that their notes did not indicate if the contact was made by phone, e-mail or another way, and that the responsible person of record would have been the family member who was called. The Administrator confirmed that (R1's) other family member was the legal contact person of record and the family member who visited was a secondary contact.

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.

cont on 9099C-2..

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 59-AS-20240315162450

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: 06/13/2024

NARRATIVE

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9099C-2... Allegation: Staff did not provide reporting agency an itemized list of fees.
The allegation states that a social worker was not provided with a copy of resident’s (R1's) invoice, showing the total balance owed, when requested by an official from a reporting agency.

On 3/20/24, the Administrator stated she sent an invoice to the social worker who had requested a copy and also sent one to the represented Ombudsman, on Friday, 3/15/24. The Administrator stated she provided a copy of the invoice on the same day she received the request.

The social worker stated she contacted the facility on several occasions, and left messages each time, but was not contacted back right away but did confirm that she was provided with a copy of the invoice on Friday, 3/15/24.

Allegation: Facility did not notify resident's responsible person of an increase in monthly rent rates. The allegation states that the facility did not notify the resident's (R1's) family member of an increase in monthly rates starting in January 2024.

The Administrator stated she spoke to the responsible person of record in November or December 2023 and confirmed that this primary contact stated she doesn't want to be involved in any way with (R1's) care and that her sister, (R1's) other daughter will be the one involved. LPA reviewed an e-mail sent on 10/31/23 from the primary contact to the Administrator with this information and another email sent on 11/4/23, from the Administrator to the second family member relating this same information.

The Administrator stated a letter addressing the annual increase would have been mailed by USPS in December 2023 and it would have been sent to the responsible person, who has been the contact person of record. The Administrator printed a copy of this letter which was generic in nature and stated the letter did not return as "undeliverable" and did not return as signed. in the bottom portion of the letter, indicating the responsible person acknowledges the increase.

cont on 9099C-3...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20240315162450

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: 06/13/2024

NARRATIVE

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9099C-3... **on 7/3/24, this page was amended to remove specific wording in the first sentence of the first paragraph only.**

The Administrator stated on 3/20/24, she sent an annual increase letter for room and board to the responsible person of record because the primary contact didn't say she didn't want to be involved until later in December 2023, confirming she took the primary person off as a responsible person at that time.

The Administrator stated that the facility is required to continue to contact the responsible person of record, until there is a change made by the courts. The Administrator stated that the second family member was made aware by phone calls, on several occasions, of the increase, effective January 2024, and billing issues were discussed. The facility continued to reach out to both family members regarding billing issues

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 to Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4