347003117-2-12-2021-27-AS-MSEY-BYAMB7-20210216082725

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347003117
Report Date: 02/12/2021
Date Signed: 02/12/2021 04:37:51 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
12/30/2019 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20191230160513

FACILITY NAME:	APPLE RIDGE ASSISTED LIVING		FACILITY NUMBER:	347003117
ADMINISTRATOR:	LISA ASHER		FACILITY TYPE:	740
ADDRESS:	3950 ANNADALE LANE		TELEPHONE:	(916) 489-6900
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95821
CAPACITY:	82	CENSUS: 25	DATE:	02/12/2021
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Michele Hardy, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident sustained unexplained bruises while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada contacted the facility via phone to conclude a complaint investigation for a complaint received on 12/30/2019. The complaint findings are being delivered via phone due to Covid-19 precautionary measures in place. LPA spoke to Michele Hardy, Administrator, and explained purpose of inspection. The results of the investigation are as follows:

Allegation: Resident sustained unexplained bruises while in care

During the investigation, LPA reviewed documentation including, but not limited to, resident's (R1) preplacement appraisal, physician's report (LIC602), periodic summary assessments (3), narrative charting notes, facility communication records/logs, Unusual Incident/Injury Report (LIC624), hospital and skilled nursing medical records, including photographs taken of resident's bruises, and other records. LPA interviewed Administrator at the time of the incident, Licensee, caregivers (4), housekeeper, other staff (1) who assisted Administrator, Home Health nurses (3), family member and another individual that knew resident. LPA obtained a department nurse consult as well prior to delivering findings.

The results of the investigation are as follows:

Skilled nursing facility records show that resident was admitted for post-acute care on 3/30/2018 following sustaining a cerebral infarction-embolic stroke with aphasia on 3/30/2018. Resident moved to facility in May 2018. LIC602 dated 4/23/2018 notes that resident requires assistance with transfers and wheelchair mobility, uses a wheelchair and hoyer lift, is non-ambulatory, has mild cognitive impairment, and needs assistance with bathing, dressing/grooming, feeding, and toileting. Preplacement Appraisal, dated 5/11/2018, states that resident is confused, can't stand, and uses a wheelchair and needs assistance getting in and out of it. Periodic summary assessments (care plans) dated 7/25/2018, 1/9/2019 and 4/11/2019 document that resident uses a wheelchair and needs a two-person assist to get in and out of it, and to transfer to and from bed. Under the category of "Fall prevention", resident's care plans dated 7/25/2018, 1/9/2019 and 4/11/2019 note that resident needs "occasional reminders to not transfer independently" and care plan dated 4/11/2019 indicates resident has "no history of falls".

cont on 9099C(1)..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) -26-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021

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

Control Number 27-AS-20191230160513

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: APPLE RIDGE ASSISTED LIVING	FACILITY NUMBER: 347003117
	VISIT DATE: 02/12/2021

NARRATIVE

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9099C(1).. The Administrator at the time of the incident stated to LPA in an interview that on 12/24/2019, a caregiver reported that resident had a bruise on the inside of her left upper arm and commented that "she (R1) is maybe getting harder to transfer". Narrative charting notes dated 12/24/2019, pm, confirm this information and note that Administrator "spoke to staff reminding them to always do a two-person assist transfer". Body/Skin Check documentation, completed by Administrator, dated 12/24/2019, indicate that resident had a bruise on the inside of her left arm.

The same staff member stated to LPA that on 12/26/2019, she, the Administrator and another staff member all observed bruises under resident's upper arm pit only that were "circular like a small apple" and that the bruises were "really dark" and could have been there for a while and were "maybe caused by resident laying on her left side" since her bed faced the wall. Photos taken during the investigation show the right side of resident's bed to be against the wall. Charting notes dated 12/25/2019 note that a second caregiver reported the bruise on resident's left inner arm and resident notes, dated 12/26/2019, no time of day noted, indicate that resident's bruise on her left arm was being monitored. Body Skin Check documentation completed on 12/26/2019, by "am" caregiver/med-tech, note that resident has old bruise on inside of left arm. Resident charting notes from 12/26/2019 only state that resident's bruise, on her left arm, specifically, was being monitored and do not indicate that resident had bruises under her upper arm pit that were circular and dark. Staff who completed the Body Skin Check on 12/26/19 worked the "am" shift and did not return to the facility until 12/29/19, "am" shift.

Charting notes dated 12/28/2019 state that a third caregiver reported resident's bruise bruise "around 7 pm", the Administrator informed the caregiver that the bruise was previously reported a couple of days ago, and that the caregiver would be completing an incident report to document her observations. Facility "Communication Record", or incident report, dated 12/28/2019 (8:00 pm) documents this caregiver reported resident to have a big bruise on her left arm and left breast. Charting notes indicate that Administrator "updated caregiver about a two-person transfer at all times". Caregiver who reported the big bruise on resident’s left arm and left breast on 12/28/2019, at 8:00 pm, stated she did not observe any bruising on 12/25/2019, was off work on 12/26/2019, and on 12/27/19, did not change resident's clothes as they were not dirty. The same caregiver explained that when she worked on 12/28/2019, she changed resident's top, prior to putting her to bed, and noticed the extensive bruising, stating "when I changed her top, I saw dark, dark bruising and she (R1) was ballistic".
cont on 9099C(2)..

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) -26-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 27-AS-20191230160513

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: APPLE RIDGE ASSISTED LIVING	FACILITY NUMBER: 347003117
	VISIT DATE: 02/12/2021

NARRATIVE

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9099C(2)…Home Health nurse stated that on 12/30/2019, resident had bruising on her upper left side and top of her left shoulder and there was "no bruising on the inside of resident's biceps but there was bruising underneath resident's breast by her rib cage" and resident was in pain. Family member stated that when home health nurse showed her in person, on 12/30/2019, how resident's lower back was healing, she noticed resident's right thigh to be swollen and to have faded, yellow bruising, in addition to the upper body bruising on resident’s left arm and left breast. Family member stated that facility staff told home health that resident had fallen in recent weeks, but she had not been made aware of any falls by the facility. Licensee and current Administrator stated that resident did not have a fall(s), adding "if she had fallen there would have been bilateral marks", not just on one side as two people would have had to help her get up, stating, "It couldn't have been a fall".

Documentation and interviews indicate that resident's family member, a Med-Tech/caregiver staff, and Administrator were all present with the home health nurse on 12/30/2019, when the bruising on resident’s upper left arm and left breast was observed. "Charting notes" and "Communication Record", completed by Administrator on 12/30/19, document that resident "has bruising on left side” as well as a “mass/bump on left breast’- and that the bruising is due to an "unknown cause" and resident had "no pain" upon being sent to ER. LIC624 dated 1/3/2020 states that on 12/30/2019, around 10:00 am, resident was observed by facility staff to have "bruising on left side and mass/bump on left breast" and was sent out immediately following this observation for further medical evaluation.

The Administrator at the time stated that facility does use a hoyer lift on resident sometimes, resident has had no falls while living at the facility, and it depends on the size of the caregiver, if one or two caregivers are needed to transfer resident (R1), who is an averaged sized resident. One staff interview revealed resident was "always a two-person transfer", was not able to help herself move or transfer and was leaning all of the time when sitting in her wheelchair. Another staff stated that " resident started out as a one-person transfer then turned into a two -person transfer months later". Additional staff interviews revealed that resident was "difficult to transfer since some caregivers need someone to help them" and "most staff will do a two-person transfer, but some might try a one-person transfer with resident". A family member of another resident stated they regularly visited their mother in the morning hours and always observed resident (R1) to be transferred with the assistance of two caregivers and staff would use a hoyer lift, at times, for resident (R1). The same family member stated that they never saw resident (R1) try and get up herself from the bed to the wheelchair and that staff could not have dressed resident (R1) and not noticed the bruises on her.
cont on 9099C(3)...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) -26-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 27-AS-20191230160513

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: APPLE RIDGE ASSISTED LIVING	FACILITY NUMBER: 347003117
	VISIT DATE: 02/12/2021

NARRATIVE

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9099C(3)...Shower documentation shows that resident was given a bed/sponge bath on 12/1/2019, 12/8/2019 and on 12/15/2019, and a shower on 12/5/2019 (pm), with a bruise noted on resident’s buttocks. Licensee stated facility received home health orders on/around 12/15/2019 to begin giving resident a bed/sponge bath due to the healing pressure sore. No additional shower documentation for subsequent days in December was provided; however, home health nurse stated that resident "was clean and showered regularly" and would be able to tell if she hadn't been.

The administrator at the time stated that staff were asked how resident sustained a mass/bump on her left breast and bruising on her left side, and no staff member was aware of how it happened. Administrator stated that resident has been on blood thinners since she moved to the facility. Medical records reviewed show that resident was prescribed Pradaxa 75 mg, 2x/day on 3/30/2018, following a stroke and continued to take the same dosage of the medication through 12/30/2019 when she left to the hospital. "Medication Release Record" shows that multiple tablets of Pradaxa 75 mg were returned to resident's family member upon discharge on 1/4/2020. Interview with home health nurse indicated that she doesn't believe resident's bruising was caused from taking blood thinners "because of the discoloration of the bruising", and because the discoloration was large and spread out, dark in some areas and different colors in other areas. The nurse confirmed that a bruise can form into a hematoma and stated that she believes "the bruising on resident's left side happened at least (2) days prior to when she saw it on 12/30/2019, as it was yellow- green in color" and was starting to heal, and that when the prior home health visit was conducted, on 12/27/2019, resident did not have any bruising on her upper body.

LPA reviewed various photographs taken by resident's family member following resident's week-long admission to the hospital on 12/30/2019 and observed multicolored bruising on resident's upper left arm and under her left arm pit and across her chest to her hip/buttocks area. Hospital medical records dated 12/30/2019 document that resident "presented with a large left -sided hematoma" with complaints of left chest wall/chest pain and tenderness. Additionally, hospital records note that the right thigh ecchymosis appeared to be in the healing stages. Photos taken at the hospital (included in medical records), showed multiple areas of bruising on resident’s upper left arm, underarm, breast area and on buttocks.

cont on 9099C(4)..

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 27-AS-20191230160513

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: APPLE RIDGE ASSISTED LIVING	FACILITY NUMBER: 347003117
	VISIT DATE: 02/12/2021

NARRATIVE

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Medical records document that resident had a surgical consult by a hospital surgeon on 12/31/2019 who noted that "Hematomas may be secondary to anticoagulants, continue holding Pradaxa".

Resident was discharged from the hospital on 1/4/2020 with a hospital summary final diagnosis: Spontaneous chest wall hematoma in the setting of systemic anticoagulation with Pradaxa.

Based on information obtained during the investigation the department was not able to establish that resident sustained bruising from physical abuse, an improper transfer or a fall and finds the allegation: Resident sustained unexplained bruises while in careto 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 via e-mail. Administrator agrees to print a copy of the report and return a signed copy to CCLD by end of day, 2/12/2021

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021

LIC9099 (FAS) - (06/04)

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