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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001594
Report Date: 07/06/2023
Date Signed: 07/06/2023 12:07:53 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2023 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230426160803
FACILITY NAME:CHRIS BEST CARE FOR ELDERLYFACILITY NUMBER:
347001594
ADMINISTRATOR:VINLUAN, LITAFACILITY TYPE:
740
ADDRESS:8208 SUMMER FALLS CIRCLETELEPHONE:
(916) 682-3942
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:5CENSUS: 3DATE:
07/06/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lita VinluanTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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2
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5
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7
8
9
Facility failed to provide supervision.
INVESTIGATION FINDINGS:
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2
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7
8
9
10
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12
13
On 07/06/2023 at 11:00 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at this facility to conduct a complaint visit. LPA Lee met with administrator, Lita Vinluan and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.

Throughout the course of this investigation, the Department conducted interviews, reviewed facility files, and reviewed medical documents.

Allegation: Facility failed to provide supervision
It was alleged that the facility failed to provide supervision. LPA conducted 4 out of 4 resident interviews and 4 out of 4 residents did not have any concern with facility staff not providing supervision. During facility visit on 04/27/2023, 05/10/2023, 06/30/2023 and today's visit LPA Lee observed 3 out of 3 residents in the common being supervised by administrator Lita Vinluan.
Continued to LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2023 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230426160803

FACILITY NAME:CHRIS BEST CARE FOR ELDERLYFACILITY NUMBER:
347001594
ADMINISTRATOR:VINLUAN, LITAFACILITY TYPE:
740
ADDRESS:8208 SUMMER FALLS CIRCLETELEPHONE:
(916) 682-3942
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:5CENSUS: 3DATE:
07/06/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lita VinluanTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are not qualified to give Insulin to resident.
Facility failed to do appraisal prior to admission.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/06/2023 at 11:00 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at this facility to conduct a complaint visit. LPA Lee met with administrator, Lita Vinluan and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.

Throughout the course of this investigation, the Department conducted interviews, reviewed facility files, and reviewed medical documents.

Allegation: Facility staff are not qualified to give Insulin to resident.
It was alleged that the facility staff are not qualified to give insulin to resident. LPA conducted 4 out of 4 resident interviews and it was learned that 1 our of 4 resident stated that resident 1 (R1) conduct (R1) insulin injections. In addition, upon reviewing (R1) LIC 602A, physican report, resident has dementhia and is not able to administer own injections. It was also learned that 4 out of 4 resident did not have a MAR sheets indicating that medications were given to residents in care. Administrator did not have a MAR sheets indicationg that (R1) was receiving (R1)'s injections.

Continued LIC 9099A
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20230426160803
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: CHRIS BEST CARE FOR ELDERLY
FACILITY NUMBER: 347001594
VISIT DATE: 07/06/2023
NARRATIVE
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Allegations: Facility failed to do appraisal prior to admission.
LPA reviewed resident files and learned that 1 out of 4 resident files were not complete. It was learned that resident 1 (R1) was missing the second page of (R1)'s LIC 603A, resident appraisal; therefore, the appraisal was incomplete.

As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

An exit interview was conducted, a copy of the LIC 9099, LIC9099-C, LIC9099-D and appeals rights were provided to the facility at this end of this visit.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20230426160803
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: CHRIS BEST CARE FOR ELDERLY
FACILITY NUMBER: 347001594
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/14/2023
Section Cited
CCR
87628(a)
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2
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87628 Diabetes
(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled profession

This
requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will ensure that all facility staff review regulations in regards to
residents who has diabetes. Licensee will write a statement stating all
staff have read and acknowledge the
regulations.
8
9
10
11
12
13
14
Based on record reviews it was learned that on R1's LIC 602A resident has dementia and is not able to administor R1's own injection.
This posed an immediate health and safety risk to residents in care.

8
9
10
11
12
13
14
Licensee will ensure to review resident's LIC 602A to ensure that resident can administor residnet's own injection prior to accepting any residents. Licensee will send
POC to LPA Lee by POC due date 07/14/2023 by 5:00 PM.
Type B
07/14/2023
Section Cited
CCR
87506(a)
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87506 Resident Records
(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.
This
requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will ensure that all facility staff reivew regulation cited. Licensee will write a statement acknowledging that all staff has read and understood the regulations.
8
9
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14
Based on record reviews it was learned that on R1's LIC 603A is not complete. R1's is missing the second page of the LIC 603A. This posed a potential health and safety risk to residents in care.
8
9
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14
Licensee will ensure that prior to accepting any resident all LIC 603A are complete and in resident files. Licensee will send POC to LPA Lee by POC due date 7/14/2023 by 5:00 PM/.
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: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20230426160803
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: CHRIS BEST CARE FOR ELDERLY
FACILITY NUMBER: 347001594
VISIT DATE: 07/06/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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21
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27
28
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31
32
As a result of this investigation, and based on LPA’s observations, and interviews the allegation(s) are deemed to be UNSUBSTANTIATED - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, the preponderance of evidence standards has not been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies are being cited.
An exit interview was conducted, and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5