347005391-4-16-2021-27-AS-MSEY-C28P4D-20210419105855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005391
Report Date: 04/16/2021
Date Signed: 04/16/2021 02:36:34 PM

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
01/05/2021 and conducted by Evaluator Melana Llopis

COMPLAINT CONTROL NUMBER: 27-AS-20210105141116

FACILITY NAME:	CARE HORIZONS ASSISTED LIVING		FACILITY NUMBER:	347005391
ADMINISTRATOR:	IORDACHE-STIR, ADRIAN		FACILITY TYPE:	740
ADDRESS:	6630 CARE LANE		TELEPHONE:	(916) 721-2073
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 6	DATE:	04/16/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Adminstrator, Adriana Iordache-stir		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff hit resident
Staff withheld medications
Staff call resident names
Staff put their fingers in resident's face
Staff are prejudice

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melana Llopis contacted the facility unannounced on 04/16/2021 via telephone due to Covid-19 and precautionary meausures to deliver complaint findings for a complaint received on 01/05/2021. LPA spoke to Administrator, Adriana Iordache-stir and explained the purpose of the call.

Throughout the course of the investigation, Community Care Licensing (CCL) conducted interviews and reviewed documentation pertinent to the allegations listed above.

The results are as follows:

***continuation on LIC9099-C***

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

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 27-AS-20210105141116

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: CARE HORIZONS ASSISTED LIVING	FACILITY NUMBER: 347005391
	VISIT DATE: 04/16/2021

NARRATIVE

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Allegation: Staff hit resident (R1)
On 01/08/2021 LPA opened the complaint and requested facility documentation for review.
Due to Covid-19 and high-priority tasks, the complaint investigation was delayed. LPA resumed complaint investigation on 04/12/2021. On 04/13/2021 LPA conducted interviews with four (4) of four (4) residents in care. Majority of residents interviewed stated the care from the staff is sufficient and resident needs are being provided for, residents have not witnessed staff hit residents, call resident names, or put their fingers in resident's faces. On 04/14/2021 LPA interviewed R1's responsible party (RP) who stated has been married to R1 for twenty-one (21) years and use to care for R1 until R1 required a higher level of care. RP stated "R1 has been to multiple facilities and this one is by far the best...the staff are excellent and very patient with R1... R1 is known to call people names, accuse them of doing things to R1, and accuse people of calling R1 names." RP stated they "facetime" R1 everyday and come to the facility frequently. RP stated "if I thought there was any sign of abuse or neglect, I would move R1 immediately."
On 04/15/2021 LPA interviewed R1's Home Health Nurse (HHN) who stated R1 is diagnosed with Bipolar disorder, R1 will go from being very nice to verbally abusive and will accuse people of doing things to her. HHN stated their "interactions with the facility have been good and observe no sign of neglect or abuse."
LPA interviewed facility staff on 04/15/2021 who stated each resident has their own challenges and the staff do their best to meet their needs. One resident will yell, scream, and call people names, however the staff choose to not take it personal. On 04/15/2021 LPA interviewed a key witness who stated the facility "staff take excellent care of the residents and are off the charts awesome," and they have "no bad word to say about the facility."

Allegation: Staff withheld medications
Complaint alleged staff wre withholding R1's NORCO medications. On 04/15/2021 LPA reviewed R1's resident file. R1's medical assessment indicates R1 has a primary diagnosis of multiple-sclerosis and secondary diagnosis of bi-polar disorder. R1's medical assessment indicates R1 has aggressive and inappropriate behavior. R1's medication list shows R1 takes NORCO for pain management and is prescribed to take as needed with 6-8 hours in between dosages.
MARS records reviewed for R1 show no errors in medications being provided to R1. Interviews with R1's responsible party (RP) stated whenever R1 needs NORCO medication for pain, RP will text the Administrator to ensure R1 gets the correct dosage as needed.

***Continuation on LIC9099-C***

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 27-AS-20210105141116

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: CARE HORIZONS ASSISTED LIVING	FACILITY NUMBER: 347005391
	VISIT DATE: 04/16/2021

NARRATIVE

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Allegation: Staff are prejudice
On 04/13/2021 LPA conducted interviews with four (4) of four (4) residents in care. Three (3) of four (4) residents interviewed stated the care from the staff is sufficient and resident needs are being provided for, residents have not witnessed staff hit residents, call resident names, or put their fingers in resident's faces. On 04/14/2021 LPA interviewed R1's responsible party (RP) who stated has been married to R1 for twenty-one (21) years and use to care for R1 until R1 required a higher level of care. RP stated "R1 has been to multiple facilities and this one is by far the best...the staff are excellent and very patient with R1... R1 is known to call people names, accuse them of doing things to R1, and accuse people of calling R1 names." RP stated they "facetime" R1 everyday and come to the facility frequently. RP stated "if I thought there was any sign of abuse or neglect, I would move R1 immediately."
On 04/15/2021 LPA interviewed R1's Home Health Nurse (HHN) who stated R1 is diagnosed with Bipolar disorder, R1 will go from being very nice to verbally abusive and will accuse people of doing things to her. HHN stated their "interactions with the facility has been good and observe no sign of neglect or abuse."
LPA interviewed facility staff on 04/15/2021 who stated "each resident has their own challenges and the staff do their best to meet their needs.. one resident will yell, scream, and call people names, however the staff choose to not take it personal." On 04/15/2021 LPA interviewed a key witness who stated the facility "staff take excellent care of the residents and are off the charts awesome," and they have "no bad word to say about the facility."

Due to the above information, LPA finds the allegation(s) to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.
Exit interview conducted via telephone with Administrator. Copy of report sent to Administrator via email. Administrator to print, sign, and send a signed copy to CCL by 04/16/2021.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 27-AS-20210105141116

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: CARE HORIZONS ASSISTED LIVING	FACILITY NUMBER: 347005391
	VISIT DATE: 04/16/2021

NARRATIVE

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Allegation: Staff call resident names
On 04/13/2021 LPA conducted interviews with four (4) of four (4) residents in care. Majority of residents interviewed stated the care from the staff is sufficient and resident needs are being provided for, residents have not witnessed staff hit residents, call resident names, or put their fingers in resident's faces. On 04/14/2021 LPA interviewed R1's responsible party (RP) who stated has been married to R1 for twenty-one (21) years and use to care for R1 until R1 required a higher level of care. RP stated "R1 has been to multiple facilities and this one is by far the best...the staff are excellent and very patient with R1... R1 is known to call people names, accuse them of doing things to R1, and accuse people of calling R1 names." RP stated they "facetime" R1 everyday and come to the facility frequently. RP stated "if I thought there was any sign of abuse or neglect, I would move R1 immediately."
On 04/15/2021 LPA interviewed R1's Home Health Nurse (HHN) who stated R1 is diagnosed with Bipolar disorder, R1 will go from being very nice to verbally abusive and will accuse people of doing things to her. HHN stated their "interactions with the facility has been good and observe no sign of neglect or abuse."
LPA interviewed facility staff on 04/15/2021 who stated "each resident has their own challenges and the staff do their best to meet their needs.. one resident will yell, scream, and call people names, however the staff choose to not take it personal." On 04/15/2021 LPA interviewed a key witness who stated the facility "staff take excellent care of the residents and are off the charts awesome," and they have "no bad word to say about the facility."

Allegation: Staff put their fingers in resident's face
On 04/13/2021 LPA conducted interviews with four (4) of four (4) residents in care. Majority of residents interviewed stated the care from the staff is sufficient and resident needs are being provided for, residents have not witnessed staff hit residents, call resident names, or put their fingers in resident's faces. On 04/14/2021 LPA interviewed R1's responsible party (RP) who stated has been married to R1 for twenty-one (21) years and use to care for R1 until R1 required a higher level of care. RP stated "R1 has been to multiple facilities and this one is by far the best...the staff are excellent and very patient with R1... R1 is known to call people names, accuse them of doing things to R1, and accuse people of calling R1 names." RP stated they "facetime" R1 everyday and come to the facility frequently. RP stated "if I thought there was any sign of abuse or neglect, I would move R1 immediately."
On 04/15/2021 LPA interviewed R1's Home Health Nurse (HHN) who stated R1 is diagnosed with Bipolar disorder, R1 will go from being very nice to verbally abusive and will accuse people of doing things to her. HHN stated their "interactions with the facility has been good and observe no sign of neglect or abuse."
LPA interviewed facility staff on 04/15/2021 who stated "each resident has their own challenges and the staff do their best to meet their needs.. one resident will yell, scream, and call people names, however the staff choose to not take it personal." On 04/15/2021 LPA interviewed a key witness who stated the facility "staff take excellent care of the residents and are off the charts awesome," and they have "no bad word to say about the facility."

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

LIC9099 (FAS) - (06/04)

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