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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347003886
Report Date: 11/24/2020
Date Signed: 11/24/2020 11:14:40 AM



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
12/12/2019 and conducted by Evaluator Bethany Huusfeldt
COMPLAINT CONTROL NUMBER: 27-AS-20191212112704
FACILITY NAME:LIVING WATER, THEFACILITY NUMBER:
347003886
ADMINISTRATOR:LAQUAGLIA, MARLANAFACILITY TYPE:
740
ADDRESS:7504 CHIPMUNK WAYTELEPHONE:
(916) 722-4056
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 0DATE:
11/24/2020
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marlana Laquaglia, LicenseeTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Resident was left on the floor for an extended period of time
Facility staff failed to meet the resident's needs
Financial Abuse
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Huusfeldt and LPM Troy Ordonez spoke with licensee Marlana Laquaglia over the phone to deliver findings due to COVID precautions.

The department investigated the allegation of “Resident was left on the floor for an extended period of time”. Through interviews and review of medical records, it was determined R1 did fall out of their bed during the night. Through review of medical records, R1 indicated at the time that they woke up and was trying to get up out of bed when they stumbled out and got wedged between the bed and the side table. Relevant Party indicated R1 informed them that R1 fell out of their bed and was on the floor for several hours. Facility staff denied R1 was left on the floor for an extensive amount of time. Another staff interview indicated R1 fell one evening (date unknown) and R1 did not call out for help so R1 was not found until the morning by another staff member. Due to conflicting information, the Department finds allegation to be UNSUBSTANTIATED.
Continuation on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany HuusfeldtTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020
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 6
Control Number 27-AS-20191212112704
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: LIVING WATER, THE
FACILITY NUMBER: 347003886
VISIT DATE: 11/24/2020
NARRATIVE
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The department investigated the allegation of “Facility staff failed to meet the resident’s needs”. The department conducted interviews and reviewed R1’s medical files. R1 fell on the floor in November 2018 and was taken to emergency room for treatment. Relevant party stated facility staff waited until the morning to call emergency services. The department was unable to determine the length of time that R1 was on the floor before facility called 911. Facility staff could not recall the incident with R1. Medical Records indicate R1 did fall on 11/30/18 and was found on the floor while trying to get out of bed. Medical records indicate R1 did not remember the entire event. Due to the information gathered the department finds allegation to be UNSUBSTANTIATED.

The department investigated the allegation of “Financial Abuse”. The department conducted interviews, reviewed resident documentation, licensee documentation, and bank records. The department reviewed R1’s bank statements and observed multiple withdrawals each month for the majority of their stay at the facility. Interviews with licensee indicated they did not manage resident money or keep track of R1 spending. Licensee stated they never took money out with R1’s bank account only received checks for monthly rent. Due to insufficient evidence, the department was unable to determine if licensee mismanaged residents funds. Due to the information gathered, LPA finds allegation to be UNSUBSTANTIATED.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

LPA reviewed report with licensee and will send a copy of report to licensee email for signature. Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany HuusfeldtTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
12/12/2019 and conducted by Evaluator Bethany Huusfeldt
COMPLAINT CONTROL NUMBER: 27-AS-20191212112704

FACILITY NAME:LIVING WATER, THEFACILITY NUMBER:
347003886
ADMINISTRATOR:LAQUAGLIA, MARLANAFACILITY TYPE:
740
ADDRESS:7504 CHIPMUNK WAYTELEPHONE:
(916) 722-4056
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 0DATE:
11/24/2020
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marlana Laquaglia, LicenseeTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Resident sustained multiple fractures while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Huusfeldt and LPM Troy Ordonez spoke with licensee Marlana Laquaglia over the phone to deliver findings due to COVID precautions.
The department investigated the allegation of “Resident sustained multiple fractures while in care”. The department conducted interviews and R1’s medical records were obtained. Medical records indicated R1 sustained a fibula fracture in June 2018 and was seen in the emergency room for the injury the following day in June 2018. Interviews were conducted with facility staff, which indicated R1 fell on a Sunday when she was returning home from attending church with friends. Interviews indicated one of R1’s friends was pushing R1 in their walker due to an injury. Due to the information gathered LPA finds allegation to be UNFOUNDED.
Copy of report will be sent to licensee by email. Exit interview conducted.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany HuusfeldtTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
12/12/2019 and conducted by Evaluator Bethany Huusfeldt
COMPLAINT CONTROL NUMBER: 27-AS-20191212112704

FACILITY NAME:LIVING WATER, THEFACILITY NUMBER:
347003886
ADMINISTRATOR:LAQUAGLIA, MARLANAFACILITY TYPE:
740
ADDRESS:7504 CHIPMUNK WAYTELEPHONE:
(916) 722-4056
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 0DATE:
11/24/2020
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marlana Laquaglia, LicenseeTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility staff failed to seek medical attention for the resident in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Huusfeldt and LPM Troy Ordonez spoke with licensee Marlana Laquaglia over the phone to deliver findings due to COVID precautions.
The department investigated the allegation of “Facility staff failed to seek medical attention for the resident in a timely manner”. The department conducted interviews and reviewed R1’s medical records. Relevant party indicated R1 fell on 6/3/18 and hurt their foot. Relevant party indicated they took R1 to the emergency room on 6/4/18. Medical records indicate R1 was taken to emergency room on 6/4/18. Medical records indicate R1 rolled her right ankle and twisted her right knee while getting out of the car on Sunday 6/3/18. R1 reported they had been icing her ankle, reported swelling and pain, and they were unable to bear weight. Staff reported that R1 did fall and injured her foot on 6/3/18.

Continuation on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany HuusfeldtTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Citations on this Visit Report are Under Appeal!

Control Number 27-AS-20191212112704
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: LIVING WATER, THE
FACILITY NUMBER: 347003886
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
11/30/2020
Section Cited
CCR
87465(a)(1)
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87465 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.
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The facility shall comply with state regulations in meeting the medical needs of all clients. The facility shall develop a procedure to follow when staff observe that any resident is in need of a medical assessment from a medical professional to ensure that medical attention is provided in a timely manner.
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This requirement is not met as evidenced by:
Based on a review of documentation, medical records, and interviews the facility staff did not seek medical attention in a timely manner for R1 for 1 day. This poses an immediate health and safety risk to residents in care.
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Procedure to be sent to LPA by 11/30/20.
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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: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany HuusfeldtTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 27-AS-20191212112704
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: LIVING WATER, THE
FACILITY NUMBER: 347003886
VISIT DATE: 11/24/2020
NARRATIVE
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Based on the investigation, there is sufficient evidence that facility staff failed to seek medical attention in a timely manner, causing resident R1 suffer physical pain for over 1 day. Staff still did not call 911. R1 was taken to the Emergency Room 6/4/18 and diagnosed with a fracture.

Due to the information gathered, LPA finds allegation to be Substantiated. As a result of this investigation, LPA finds allegations 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: Refer to the 9099-D.

Exit interview conducted and appeal rights given. LPA will email report to licensee for review and signature.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany HuusfeldtTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020
LIC9099 (FAS) - (06/04)
Page: 5 of 6