347005209-2-8-2023-25-AS-KHOS-CP4QSB-20230216112515

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005209
Report Date: 02/08/2023
Date Signed: 02/08/2023 11:15:44 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
10/13/2022 and conducted by Evaluator Sarena Keosavang

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20221013123708

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: 6	DATE:	02/08/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Helen Tan- Administrator		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

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Facility staff member verbally abused resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced 02/08/2023 to deliver final finding for a complaint Community Care Licensing (CCL) received on 10/13/2022. LPA met with Administrator, Helen Tan, and explained the purpose of the visit. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility.

Throughout the course of the complaint investigation the Department conducted interviews and obtained pertinent documents, such as resident’s (R1) physician's report, identification, and emergency information, assisted living waiver program individual service plan, preplacement appraisal information, and SOC 341.

Continued on page LIC-9099C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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 3

Control Number 25-AS-20221013123708

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BEST LIFE HOME CARE, LLC.	FACILITY NUMBER: 347005209
	VISIT DATE: 02/08/2023

NARRATIVE

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According to complainant, staff (S1) verbally abused resident while in care. R1 had soiled on self and S1 was attending to R1. R1 was confused and S1 was becoming more agitated accusing R1 of being argumentative. S1 was using course language and raising S1’s voice to yell while addressing R1.

The Department reviewed R1’s physician’s report. Physician’s report indicated R1 has mild cognitive impairment. Physical health status indicated R1 has bowel impairment and bladder impairment.

The Department received statement from two (2) witnesses that confirmed S1 verbally abused resident while in care. Witness (W1) stated R1 had defecated on self and S1 was assisting R1. W1 heard S1 yell “Take off your clothes!” W1 stated S1 was being demeaning towards R1. W2 witnessed R1 nude standing in front of S1 while R1 was being berated. W2 stated S1 was yelling “Cut the attitude!” “I don’t want to hear it!” “Stop arguing and do it!” “Because it got crap all over it, there’s crap all over your shirt!” “Because I told you to stop arguing. I’m tired of you arguing with me!” “When I tell you keep your mouth shut!” “Quiet your ass!” “Good, leave.” W2 heard R1 asking S2, “Why are you talking to me this way!” “You are not nice; I am going to leave.” Other residents in care overheard S1 and R1’s interaction which added further humiliation to R1.

Due to this information CCL finds the allegation to be SUBSTANTIATED. – A finding that the complaint is substantiated means that the allegations is valid because the preponderance of the evidence standard has been met.

Deficiencies are cited on the attached LIC 9099-D.

Appeal rights were provided.

An exit interview was conducted, and a copy of the report left at the facility.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 25-AS-20221013123708

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BEST LIFE HOME CARE, LLC.	FACILITY NUMBER: 347005209
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type A 02/10/2023 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews,	1 2 3 4 5 6 7	Administrator to review regulation 87468.1 concerning resident rights. Administrator to write a statement of understanding concerning resident rights. Statement of understanding to be sent into CCL by POC due date,
	8 9 10 11 12 13 14	Administrator did not ensure resident was accorded dignity in their relationship with staff which posed an immediate and safety risk to residents in care.	8 9 10 11 12 13 14
Request Denied Type A 02/17/2023 Section Cited CCR 87468.1(a)(3))	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping,	1 2 3 4 5 6 7	Administrator agrees to have an outside vendor conduct an in-service training regarding personal rights of residence in care. Licensee agrees to provide CCL proof of training by POC due date, 2/17/2023.
	8 9 10 11 12 13 14	or elimination.This requirement was not met as evidenced by: Based on interviews, , Administrator did not ensure resident was free from humiliation during incontinence incident which posed an immediate and safety risk to residents in care.	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: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC9099 (FAS) - (06/04)

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