347005251-7-11-2023-59-AS-MSEY-CTTNCC-20230717102033

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005251
Report Date: 07/11/2023
Date Signed: 07/11/2023 12:50:53 PM

Substantiated

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
05/31/2023 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20230531123647

FACILITY NAME:	ATRIA CARMICHAEL OAKS		FACILITY NUMBER:	347005251
ADMINISTRATOR:	HAGEN, KIMBERLY		FACILITY TYPE:	740
ADDRESS:	8350 FAIR OAKS BLVD		TELEPHONE:	(916) 944-2323
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	95	CENSUS: 69	DATE:	07/11/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Christina Ortiz		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Resident personal rights violated by facility staff through improper placement in memory care

INVESTIGATION FINDINGS:

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On 7/11/23, Licensing Program Analyst (LPA) Kevin Mknelly spoke to Christina Ortiz, Assistant Executive Director, to deliver complaint findings for the above allegation. LPA also spoke with Kimberly Hagen, Executive Director by phone.

LPA reviewed resident records, facility records and conducted extensive interviews.
LPA finds that the allegations cited above are substantiated.
In April 2023, R1 was admitted to the facility with an LIC 602- Physician’s Report diagnosis of dementia. At the time of admission, R1 presented with assistance needs where it was determined that placement in the memory care wing appeared most appropriate. At that time, R1 and their responsible party agreed to the placement.

On 5/25/23, R1 was seen by a physician who changed the diagnosis from dementia to R1 having had delirium that was now resolved. By 5/25/23, R1 was voicing their desire, to family and facility staff, to no longer live in the memory care wing and wished to move to assisted living.

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: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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 4

Control Number 59-AS-20230531123647

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: ATRIA CARMICHAEL OAKS	FACILITY NUMBER: 347005251
	VISIT DATE: 07/11/2023

NARRATIVE

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On or about 5/30/23, a meeting was held between R1, R1’s Power of attorney (POA), Ombudsman and Atria’s Administrator. In the meeting, all parties agreed that for R1’s stability and as R1 plans to move from the facility soon, a compromise plan would be put in place where R1 would continue to have a room in memory care but be allowed to join activities, as they wished, in assisted living in order to associate with other residents.

However, Atria staff were concerned about R1’s decision making and made R1’s movement within the community contingent upon staff availability. In interviews on 6/14/23 and 6/28/23 R1 and Atria staff reported that R1 at times would refuse the offers to join assisted living activities and when R1 changed their mind, staff were not always available to escort R1 immediately. On 6/27/23, R1 was offered an assisted living activity and declined. Shortly thereafter, R1 stated they wished to go to the activity. R1 then insisted and was denied until staff were available. R1 then chose to exit memory care through a side gate and was attended to by staff who escorted R1 back to memory care.

R1’s POA forwarded a copy of the updated LIC 602 on 6/9/23. In interview with the Director on 6/14/23, the director expressed concerns with the change in diagnosis and some behaviors on the part of R1. The facility staff had not reached out to the physician who authored the report to voice concerns and observations of R1. While LPA acknowledged the concerns of the Director, LPA again emphasized that those concerns and need for supervision also apply to some residents in assisted living, who have cognitive deficits, who are not one-to-one, nor have their movements or associations with others restricted to a memory care placement. Staffing and communications appropriate to R1’s needs were discussed.
R1 has since moved from the facility to live with family.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 59-AS-20230531123647

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: ATRIA CARMICHAEL OAKS	FACILITY NUMBER: 347005251
	VISIT DATE: 07/11/2023

NARRATIVE

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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.

Report reviewed with Christina Ortiz. Copy of this report and appeal rights provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20230531123647

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: ATRIA CARMICHAEL OAKS	FACILITY NUMBER: 347005251
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/11/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/03/2023 Section Cited CCR 87705(k)(9)	1 2 3 4 5 6 7	Care of Persons with Dementia (k) The following... requirements must be met for the licensee to utilize delayed egress devices ...: (9) The licensee shall not ... retain residents determined by a physician to have a primary diagnosis of a mental disorder unrelated to dementia.	1 2 3 4 5 6 7	R1 has moved from the facility. Licensee will submit proof of retraining of staff regarding resident rights to specifcally include to leave the facility, have relationships with other residents and to only include others in personal issues/ discussions with resident consent or legal guardian status.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by statements of R1, R1’s family and facility staff that found R1’s movement throughout the community was restricted, at times, due to staff unavailability though R1 no longer had a diagnosis of dementia. This posed an immediate risk to R1’s personal rights.	8 9 10 11 12 13 14	The POC is due by 7/25/23.
	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: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC9099 (FAS) - (06/04)

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