347002889-6-17-2020-27-AS-TORZ-BQVUW5-20200624155608

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347002889
Report Date: 06/17/2020
Date Signed: 06/17/2020 01:15:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/28/2020 and conducted by Evaluator Bethany Huusfeldt

COMPLAINT CONTROL NUMBER: 27-AS-20200228080026

FACILITY NAME:	GOLDEN CREST CARE CENTER		FACILITY NUMBER:	347002889
ADMINISTRATOR:	VICTOR BURACHEK		FACILITY TYPE:	740
ADDRESS:	8120 PATTON AVENUE		TELEPHONE:	(916) 725-6766
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 6	DATE:	06/17/2020
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Victor buracheck, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff is mismanaging resident's medications.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Huusfeldt spoke with licensee Victor Burachek on 6/17/20 to deliver complaint findings. Due to COVID-19 restrictions LPA spoke to licensee over the phone.
LPA investigated allegation of “Staff is mismanaging resident's medications”. LPA interviewed staff and residents and conducted a record review. LPA reviewed physician order for R1 dated 2/11/20. The order increased lisinopril to 20 mg daily, discontinues amlodipine, decreases to metoprolol to once daily, and ordered lab work. Relevant party indicates R1’s metoprolol was changed from 50 mg twice daily to 50 mg once daily, and administrator is administering R1 metoprolol 25 mg twice daily which is not prescribed. Interviews with administrator indicated, R1 had a doctor appointment on 2/11/20, in which administrator was present for. Administrator had observed health concerns in R1, in which R1’s doctor prescribed a long lasting 50 mg metoprolol one time daily.
Conituation on 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2020

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 27-AS-20200228080026

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: GOLDEN CREST CARE CENTER	FACILITY NUMBER: 347002889
	VISIT DATE: 06/17/2020

NARRATIVE

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Administrator stated he went to pick up the new medication however the pharmacy did not have a long lasting metoprolol option. Administrator indicated pharmacist advised for administrator to cut 50 mg tab in half and give once in the morning and once in the evening which would give the same effect. Administrator was unable to provide documentation from pharmacist. LPA interviewed R1 in which they indicated during their 2/11/20 doctor appointment, doctor spoke to administrator about a long lasting metoprolol option. R1 indicated they were not present with administrator when administrator picked up the new order of metoprolol. LPA was unable to get a hold of relevant party for further questioning.

Due to the information gathered, LPA finds 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 conducted. Licensee agrees to send signed document back to LPA.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2020

LIC9099 (FAS) - (06/04)

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