347001667-6-9-2023-59-AS-MSEY-CSZVKR-20230621163045

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001667
Report Date: 06/09/2023
Date Signed: 06/09/2023 05:00:14 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, 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
03/28/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230328173353

FACILITY NAME:	LUCIAN'S HOME		FACILITY NUMBER:	347001667
ADMINISTRATOR:	MITITI, VASILE LUCIAN		FACILITY TYPE:	740
ADDRESS:	8254 MOSS OAK AVENUE		TELEPHONE:	(916) 879-0879
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 6	DATE:	06/09/2023
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Dan Matiti, Co- Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Residents are chemically restrained with medication
Facility staff not fingerprint-cleared
Staff are using drugs while on duty
Facility staff are abusing residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived at the facility unannounced to deliver findings to a complaint received on March 28, 2023. LPA met Dan Mititi, Administrator,and explained purpose of inspection. Also present was caregiver, Alexa Mititi. LPA observed (3) residents in the common area and (3) residents in their rooms.

During the investigation, LPA reviewed personnel files for Co-Administrator and (3) staff (S1,S2 and S3) and obtained copies of documentation, including staff training. LPA reviewed medications for (3) residents and related documentation as well as an LIC500. LPA obtained an updated copy of the LIC500 to reflect staffing changes that were made effective 5/11/2023. S1 and S2 no longer are employed at the facility.

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: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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-20230328173353

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: LUCIAN'S HOME	FACILITY NUMBER: 347001667
	VISIT DATE: 06/09/2023

NARRATIVE

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9099C(1).. Allegation: Residents are chemically restrained with medication. Complaint alleges that staff are giving residents medication to keep them sleeping.

One resident stated that she receives medications from staff and she is given what the doctor has prescribed. A second resident stated she is always given the correct medications and takes Ibuprofen, if needed, for extra pain she may have. Two staff (S1 and S2) confirmed they do not administer meds and the Administrator, Dan, is the only one administering medications. (S1 and S2) stated that residents sleep well at night and no one is given sleeping pills. Administrator, Dan, stated he prepares the medications and also administers them to the residents and staff (S1) was trained to administer medications but is no longer working at the facility. Administrator stated he is "very organized in how the meds are done" and there are "no issues with meds". LPA and Administrator reviewed medications ordered to those being given for (3) residents on 4/4/2023 and found no errors. Medications are also being documented correctly on the LIC625 and when given as a PRN medication, as required. Residents were observed to be awake and interacting with each other during multiple inspections and eating dinner together on 6/9/2023 at approximately 4:30 pm.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Allegation: Facility staff not fingerprint cleared. Complaint alleges that some staff are undocumented and are not finger-print cleared. LPA reviewed staffing records and schedules and confirmed that all staff are finger-print cleared and associated to the facility. In addition, LPA confirmed multiple staff's identity from a photo ID or passport.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Allegation: Staff are using drugs while on duty. Complaint alleges that staff are using drugs while on duty.All staff interviewed stated no staff are under the influence of alcohol or any drug that would prevent them from providing care and supervision to the residents. LPA observed staff to be competently assisting residents and able to perform their jobs on 6/9/2023 and during another recent inspections in April 2023. Residents all indicated they receive excellent care and promptly when requested.
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: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20230328173353

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: LUCIAN'S HOME	FACILITY NUMBER: 347001667
	VISIT DATE: 06/09/2023

NARRATIVE

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9099C(2)One resident stated staff is "very good about assisting me" and a second resident stated staff always "spoil us- (S1)makes me a milk shake a lot". Administrator stated staff do not use drugs, and there are no drugs at the facility. One resident stated there are "no issues with staff being able to do their job".

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Allegation: Facility staff are abusing residents. Complaint alleges that staff are abusing residents with no specific details provided.

Staff (S2) was asked if there was any abuse at the facility and she stated "no, there is none of that- we give the residents compliments and the residents give us compliments", asserting "everything is going great". Administrator stated there is absolutely no abuse of any kind at the facility, and all residents, but one, have lived at the facility for at least one year and families are very happy with the care being provided. All residents interviewed stated there has never been any abuse to residents and staff provides excellent care.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis.

All allegations were determined to be unfounded.

There are no deficiencies cited and the complaint is being dismissed.

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: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC9099 (FAS) - (06/04)

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