347003628-11-20-2023-59-AS-MSEY-CXTNP8-20231122093752

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347003628
Report Date: 11/20/2023
Date Signed: 11/20/2023 12:31:22 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
08/28/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230828125407

FACILITY NAME:	SUGAR MAPLE CARE HOME		FACILITY NUMBER:	347003628
ADMINISTRATOR:	SOTEA, FLORICA		FACILITY TYPE:	740
ADDRESS:	6737 SUGAR MAPLE WAY		TELEPHONE:	(916) 222-2022
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 6	DATE:	11/20/2023
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Florica Sotea, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Neglect/Lack of Supervision: Due to staff's neglect or lack of care, resident received a medication not prescribed, fentanyl, while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver investigative findings to a complaint received on 8/28/23. LPA met with Florica Sotea, Administrator, and explained purpose of inspection.

During the investigation, the Department interviewed (2) facility staff, (4) residents, the Ombudsman and a hospital staff person. Multiple documentation pertaining to resident (R1) was reviewed, including hospital medical records, facility records, and medication records. Medication records were also reviewed for all residents. The results of the investigation are as follows:

On 8/23/23, resident (R1) was reported to be laughing and smiling and not interacting as resident normally does in conversation. The Administrator took resident to a scheduled psychiatric appointment and expressed her concerns of resident's altered behavior to the psychiatrist, who contacted 911.

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: 11/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

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 2

Control Number 59-AS-20230828125407

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: SUGAR MAPLE CARE HOME	FACILITY NUMBER: 347003628
	VISIT DATE: 11/20/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

9099C-1.. On 8/23/23, at approximately 2:32 pm, the resident was transported by ambulance to an area hospital and admitted for an increased altered level of consciousness, weakness, hypotension, respiratory failure and bradycardia (slow heart rate). Resident's urinalysis test returned positive for fentanyl. A second test was not conducted. Fentanyl was not a medication on resident's medication list. Hospital notes were reviewed and note the pulmonologist wrote "Possible false positive urine test due to a cross reaction with other drugs".

There was no evidence to indicate the presence of fentanyl in the facility. The Administrator stated that none of the residents were prescribed fentanyl which was consistent with resident record reviews. The Department conducted an on-line search of resident's (R1's) medications and their ingredients, as well as the medication ingredients of all residents, and no medications were determined to contain fentanyl as an ingredient. Resident's medication labels on the medication containers were also reviewed and none were observed to list fentanyl.

Both the Administrator and caregiver denied taking fentanyl. The Administrator also indicated that resident (R1) had no access to any medications and did not manage her own medications, confirming the medications were kept locked in a cabinet. The Administrator or caregiver administered all of resident's medications and the resident (R1) did not leave the facility or have any visitors leading up to the incident. The local police department conducted an investigation and was unable to find any evidence of a crime and closed their case as information only.

Resident, (R2), reported she received another resident's medication once but immediately recognized the incorrect medication and advised staff. The same resident recalled another time when another resident, whose name was not known, received an incorrect medication and told staff "This isn't mine". Staff corrected the medication error before the resident took the wrong medication. R2 stated that the Administrator will prepare medications for all residents and store them in a kitchen drawer. The Administrator confirmed all medications are stored in a locked cabinet and no where else in the home. The Administrator showed LPA on 11/20/23 that she prepares the medications only for the day (all dosages) and administers the medications with a meal when possible. LPA observed each medicine cup to be labeled with resident's name.

As a result of this investigation, the Department finds the allegation to be (US)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 the Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2