347005209-5-10-2022-25-AS-KHOS-CEGNF4-20220516102454

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005209
Report Date: 05/10/2022
Date Signed: 05/10/2022 04:16:21 PM

Unsubstantiated

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
10/21/2021 and conducted by Evaluator Michael Hood

COMPLAINT CONTROL NUMBER: 25-AS-20211021160943

FACILITY NAME:	BEST LIFE HOME CARE, LLC.		FACILITY NUMBER:	347005209
ADMINISTRATOR:	BUTTS, CHRIS		FACILITY TYPE:	740
ADDRESS:	7205 BARANGA DRIVE		TELEPHONE:	(916) 726-2292
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	6	CENSUS: 5	DATE:	05/10/2022
		UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Helen Tan, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Resident sustained fracture while in care

Staff did not assist resident with their medication

Staff are not following resident's mobility care plan

Resident was left on soiled linens for an extended period of time

INVESTIGATION FINDINGS:

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On 5/10/2022, Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Helen Tan, to conclude a complaint investigation into the allegations listed above. LPA wore an N-95 mask. Facility staff wore masks while on the premises.

During the investigation, the department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows:

Allegation: Resident sustained fracture while in care

** Report continued on 9099-C **

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: 916-531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022

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 3

Control Number 25-AS-20211021160943

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: BEST LIFE HOME CARE, LLC.	FACILITY NUMBER: 347005209
	VISIT DATE: 05/10/2022

NARRATIVE

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Interviews with relevant parties indicated that R1 experienced surgery prior to admission at the facility. Admission Agreement for R1 states that R1 was admitted to the facility on 1/17/2019. Interviews with relevant parties indicated that R1 had a hip and ball replacement in December of 2018. Interviews with relevant parties indicated that R1’s hip fracture occurred prior to admission at the facility.

R1’s Preplacement Appraisal Information states that R1 had “recent hip surgery” and that, on 11/18/2018, R1 had “surgery to replace hip ball.”

Allegation: Staff did not assist resident with their medication

Interviews with staff members S1 and S2, and relevant parties indicated that PRN medications for R1 were administered as needed for R1 during their time at the facility.

During interview conducted with R1 on 10/28/21, R1 stated that staff provide "good" care and treat the residents well. R1 stated that they have been taken care of well. R1 stated that they were not experiencing any pain and that care staff help with R1’s pain management “just fine.”

Allegation: Staff are not following resident's mobility care plan

R1’s California Assisted Living Waiver (ALW) Program Individual Service Plans (ISPs) dated for 12/11/2018, 3/18/2021, and 12/9/2021 state that facility will encourage member to continue daily exercises, assist in obtaining mobility devices as needed, evaluate the use of assisted devices, check member every 2 hours for falls, and encourage member to continue compliance with using cane.

Interviews with S1 and S2 indicated that R1 receives transfer assistance when moving from bed to wheelchair. Interviews with relevant parties indicated that facility follows R1’s mobility plan as indicated in R1’s ISPs.

Allegation: Resident was left on soiled linens for an extended period of time

** Report continued on 9099-C **

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: 916-531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 25-AS-20211021160943

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: BEST LIFE HOME CARE, LLC.	FACILITY NUMBER: 347005209
	VISIT DATE: 05/10/2022

NARRATIVE

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R1’s ISPs dated 12/11/2018, 3/18/2021, and 12/9/2021 states that facility will offer toileting every 2 hours for R1. Interviews with S1 and S2, and relevant parties indicate that the facility is checking on R1 every 2 hours to see if R1 needs assistance with incontinence care.

Based on interviews conducted by the Department and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation 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 was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: 916-531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022

LIC9099 (FAS) - (06/04)

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