347005264-9-8-2020-27-AS-JLUD-BT9UQN-20200908154725

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 347005264
Report Date: 09/08/2020
Date Signed: 09/08/2020 03:47:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME:	STAINLESS RESIDENTIAL CARE FACILITY		FACILITY NUMBER:	347005264
ADMINISTRATOR:	JUSTICE O EHIMAMIEGHO		FACILITY TYPE:	740
ADDRESS:	407 MAPLE STREET		TELEPHONE:	(916) 821-2391
CITY:	GALT	STATE: CA	ZIP CODE:	95632
CAPACITY:	18	CENSUS: 13	DATE:	09/08/2020
TYPE OF VISIT:	Case Management - Legal/Non-compliance	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Licensee Princess Amas-Jonhson & Administrator Justice O Ehimamieg		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Unannounced complaint visit (Call) via conference call on 09/8/2020 to follow up on a substantiated allegation of neglect/lack of supervision. LPA’s Jason Lund & Bruce Jacobs spoke with Administrator, Justice O Ehimamiegho and Licensee, Princess Amas-Johnson. Current census was 13 residents. On December 5, 2019 the Department concluded a complaint investigation which alleged the following: a resident (R1) sustained fractures by an unknown cause, R1 was malnourished, and R1 smelled of urine. The allegations were substantiated, and the licensee was cited for violating California Code of Regulations (CCR) CCR Title 22, § 87646(1)(3) - Basic Services for staff failing to provide supervision resulting in the resident sustaining multiple injuries and for staff failing to ensure that R1 was receiving proper nutrition that resulted in R1 being malnourished. The facility was also cited for violating CCR Title 22, § 87625(b)(3) – Managed Incontinence due to the resident smelling of urine.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: STAINLESS RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 347005264
	VISIT DATE: 09/08/2020

NARRATIVE

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The investigation revealed that R1 was admitted to a general acute care hospital on February 1, 2019 and discharged on February 15, 2019. Upon admission, the primary physician diagnosed R1 with right ear contusion, right facial ear contusion, and right facial contusion. According to Mayo Clinic, contusion also known as a bruise forms when a blow breaks blood vessels near the skin’s surface, allowing a small amount of blood to leak into the tissues under the skin. The physician also diagnosed R1 with acute fracture of R1’s left 10^th, 11^th rib and subacute fracture of the left 12^th rib, right 4^th rib and subacute fracture of the lumbar 1 to 4 transverse process. The subacute transverse process fractures left lumbar 1 to lumbar 4 were noted as "healing". The 12^th and 4^th rib fractures were noted and non-acute. The exact cause of the injuries was not determined. R1 was also diagnosed with subcapsular hematoma spleen without obvious laceration, grade 11. Medline Plus defines hematoma as bleeding or the loss of blood. R1 was diagnosed further with sacral and buttock ecchymosis. According to Medline Plus, ecchymosis is blood that can collect under the tissue, or a very large bruised area. R1 was diagnosed with left AC fossa erythema and right elbow abrasion. According to John Hopkins Medical, an abrasion is when the top layers of skin get rubbed away.

The investigation also revealed, while R1 was admitted to a general acute care hospital on February 1, 2019 through February 15, 2019, the primary physician diagnosed R1 with BMI under 14.9 and severe protein-calorie malnutrition. Per the CDC, Body Mass Index (BMI) is a person’s weight in Kilograms divided by the square of height in meters. A BMI below 19 is considered underweight. R1 was admitted to the facility on October 1, 2017. R1's weight was noted as 127lbs on April 27, 2017. Upon admission to the acute care hospital on February 1, 2019, R1’s weight was 103.9lbs. According to Mayo Clinic malnutrition, is a condition that results from lack of sufficient nutrients in the body.

The investigation revealed that R1 arrived at a Veterans Hospital on February 1, 2019 but was transferred to a general acute care hospital on the same day and remained in care through February 15, 2019. The primary physician diagnosed R1 with fractures, bruising (Exact cause of the injuries was not determined) and being malnourished while at the care facility. Facility staff denied any falls or trauma occurring to R1 even though the injuries noted were too significant for staff not to have observed.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2020

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: STAINLESS RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 347005264
	VISIT DATE: 09/08/2020

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Based on medical records and interviews, the licensee failed to provide care and supervision, resulting in R1 sustaining multiple injuries including bruising and bone fractures which is serious bodily injury. The licensee also failed to provide care and supervision which resulted in R1 being malnourished.

At the time of the complaint visit on December 5, 2019, the issuance of a civil penalty was still being determined. However, the licensee was informed that a civil penalty might be assessed based on Health and Safety Code § 1569.49.

The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. Per Welfare and Institutions Code § 15610.67 defines serious bodily injury as “an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.”

On 9/8/20, the Department issued a civil penalty per Health and Safety Code § 1569.49, for a violation that the Department constituted as serious bodily injury in the amount of $10,000. A copy of the LIC 421D was emailed to Licensee, Princess Amas-Johnson for her signature to be emailed back to LPA Jason Lund.

Exit interview conducted. Appeal Rights provided. A copy of the report issued to Licensee, Princess Amas-Johnson was emailed at pamas.src@gmail.com for her signature to be emailed back to LPA Jason Lund.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2020

LIC809 (FAS) - (06/04)

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