347003712-4-19-2021-27-AS-MSEY-C2AKXW-20210421081810

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347003712
Report Date: 04/19/2021
Date Signed: 04/19/2021 05:46:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/16/2020 and conducted by Evaluator Kevin Mknelly

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20201116134611

FACILITY NAME:	BROOKDALE CITRUS HEIGHTS		FACILITY NUMBER:	347003712
ADMINISTRATOR:	SCARBERRY, JENNIFER		FACILITY TYPE:	740
ADDRESS:	7375 STOCK RANCH RD		TELEPHONE:	(916) 729-2722
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	56	CENSUS: 20	DATE:	04/19/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Sharon Monck		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Facility staff failed to protect resident's person property from theft and loss.
Facility staff failed to seek timely medical care for resident.
Facility overcharged resident for services

INVESTIGATION FINDINGS:

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On (date), Licensing Program Analyst (LPA) Kevin Mknelly spoke with Sharon Monck, acting administrator for Brookdale Citrus Heights at approximately 10:30 AM via WebEx. Also on the call were
LPA was unable to meet at the facility due to current circumstances.

LPA reviewed resident records, facility records and conducted extensive interviews.
LPA finds that the allegations cited above are substantiated.

LPA reviewed facility records and police records. It was found that on 7/3/20, a home aid organization that was contracted by the facility sent S1 to the facility. The investigation conducted by Community Care Licensing and the Sacramento County Sheriff found that S1 stole R1’s credit card. The credit card was fraudulently used for approximately $2400.
87468.2 Additional Personal Rights of Residents in Privately Operated Facilities(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental,

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021

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-20201116134611

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BROOKDALE CITRUS HEIGHTS	FACILITY NUMBER: 347003712
	VISIT DATE: 04/19/2021

NARRATIVE

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physical, or sexual abuse. This requirement was not net as evidenced by records and statements that S1 committed the crime when at the facility without supervision as outlined in Provider Information Notice (PIN) 20-37-ASC. This posed immediate risk to resident’s personal rights.

LPA reviewed facility records and statements- R1’s responsible party made staff aware that R1 was experiencing toe pain in early October. Statements by facility Wellness Director, Sumit Benipal, acknowledged that R1 needed podiatry care. In a care conference with R1’s primary physician, behavioral issues were discussed, and the physician was aware of leg swelling yet physician’s direction for the overgrown nails was not sought. There were scheduling issues with podiatry care in residence and other providers were also found to be unavailable. As of 11/18/20, R1 did not receive service for the overgrown toenails that were causing them pain. Wellness Director acknowledged that a resident with lower extremity circulation issues should have podiatry concerns addressed in a timely manner.
87465 (a)(1) Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidence by records and statements that arrangements were not made for R1’ medical condition. This posed an immediate risk to the resident.

LPA reviewed facility records and statements which found the responsible party for R1 received incorrect billing for July – November 2020, for amounts in excess of the terms and fees agreed to in R1’s admission agreement. Administrator, Jennifer Scarberry was aware of the overbilling, yet the error was not corrected throughout R1’s stay at the facility.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20201116134611

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BROOKDALE CITRUS HEIGHTS	FACILITY NUMBER: 347003712
	VISIT DATE: 04/19/2021

NARRATIVE

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87507(g)(3)(B)(2) Admission Agreements (g) Admission agreements shall specify the following: (3) Payment provisions, including the following: (B) Rate for additional items and services, including: 2. A separate charge for an item or service may be assessed only if that charge is included in and authorized by the admission agreement. This requirement was not met as evidenced by records and statements. This posed a potential risk to resident and their finances.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

Unable to obtain signature. Signature present on hard copy in file. LPA sent a copy of report for Sharon Monck to sign. Administrator to send a signed copy back to CCL.
Additionally, LPA sent a copy of the appeal rights.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20201116134611

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BROOKDALE CITRUS HEIGHTS	FACILITY NUMBER: 347003712
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/19/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/20/2021 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	Additional Personal Rights of Residents in Privately Operated Facilities(a)... residents ... shall have all of the following personal rights: (8) To be free from neglect, financial exploitation,...This requirement was not net as evidenced by records and statements that S1 committed the crime when at the facility without supervision as outlined in	1 2 3 4 5 6 7	Licensee will submit the facility's plan to insure temporary staff are proerly screen, supervised and have files that comply with staffing regulations.
	8 9 10 11 12 13 14	Provider Information Notice (PIN) 20-37-ASC. This posed immediate risk to resident’s personal rights.	8 9 10 11 12 13 14
Type A 04/20/2021 Section Cited CCR 87465(a)(1)	1 2 3 4 5 6 7	Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility...(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.	1 2 3 4 5 6 7	Licensee will submit a plan for how resident medical needs will be addressed when primary care or specialty care is unavailable. The paln will be submitted to CCL by the POC date of 4/20/21.
	8 9 10 11 12 13 14	This requirement was not met as evidence by records and statements that arrangements were not made for R1’ medical condition. This posed an immediate risk to the resident.	8 9 10 11 12 13 14

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: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 27-AS-20201116134611

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BROOKDALE CITRUS HEIGHTS	FACILITY NUMBER: 347003712
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/19/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/03/2021 Section Cited CCR 87507(g)(3)(B)(2)	1 2 3 4 5 6 7	Admission Agreements (g) Admission agreements shall specify the following: (3) Payment provisions, including the following: (B) Rate for additional items and services, including: 2. A separate charge for an item or service may be assessed only if that charge is included in and authorized by the admission agreement.	1 2 3 4 5 6 7	Licensee will review the billing errors that were present in this case and submit a plan for how similar errprs will be corrected in a timely manner in the future. The paln will be submitted by the POC date of 5/3/21.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by records and statements which found charges in excess of those agreed to. This posed a potential risk to resident and their finances.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021

LIC9099 (FAS) - (06/04)

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