347005512-7-13-2023-27-AS-KHOS-CU4PX8-20230726114154

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005512
Report Date: 07/13/2023
Date Signed: 07/13/2023 02:54:56 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/10/2023 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230310112136

FACILITY NAME:	ELK GROVE PARK ASST. LVG AND MEMORY CARE COMMUNITY		FACILITY NUMBER:	347005512
ADMINISTRATOR:	JAMES HALL		FACILITY TYPE:	740
ADDRESS:	6727 LAGUNA PARK DR		TELEPHONE:	(916) 683-1881
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	108	CENSUS: 54	DATE:	07/13/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Morgan Whinery		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure residents responsible parties are informed of epidemic outbreaks.
Staff do not ensure resident records are maintained.
Staff do not ensure soiled gloves are properly discarded after use.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Morgan Whinery and explained the purpose of the visit.

This investigation consisted of review of facility records, review of resident records, and interviews with Whinery, eight staff members (S1-S8) and five residents (R2-R6).

LPA Moleski reviewed R1’s LIC 602, R1's medication administration records (MARs) for the months of January, February, and March of 2023, two incident reports involving R1, and daily notes for R1. LPA Moleski also reviewed widespread illness trackers showing which residents and staff experienced symptoms of and/or tested positive for Noro Virus during an outbreak, and a letter that was posted in the facility and sent out to families during the outbreak of Noro Virus, according to S1. LPA Moleski reviewed a photograph of this letter posted on official letterhead. [continued on 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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 2

Control Number 27-AS-20230310112136

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ELK GROVE PARK ASST. LVG AND MEMORY CARE COMMUNITY	FACILITY NUMBER: 347005512
	VISIT DATE: 07/13/2023

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
26
27
28
29
30
31
32

R1’s LIC 602 and R1’s MARs both contained R1’s allergy information.

According to the widespread illness trackers, the first resident to fall ill began showing symptoms on February 26, 2023. The letter reviewed by LPA Moleski stated that “active GI” [gastrointestinal] “infection cases” were “impacting our Elk Grove Park Family.” The letter includes several infection control guidelines intended to “end the outbreak much sooner.” According to S1, the letter was posted and sent out to families on March 5, 2023, which is seven days after the first resident onset documented in the widespread illness tracker. The photographed posting of this letter reviewed by LPA Moleski was dated March 5, 2023. S1 told LPA Moleski that staff also made phone calls to families of residents, including those who had not tested positive for Noro Virus, in order to inform them of the outbreak. S1 told LPA Moleski on March 6 that the facility would be testing residents for Noro Virus. As of March 7, three residents were still symptomatic, according to S1. As of March 10, S1 had received lab results indicating that all three of those residents were positive for Noro Virus. By that time, no residents were still symptomatic, according to S1.

During interviews, S2-S8 described proper use of PPE and proper glove disposal procedures. None said they had witnessed any other staff members using soiled gloves. During interviews, R2, R3, R4, and R6 said they had never seen staff using soiled gloves. R5 described an incident that allegedly occurred six months previously in which staff did not properly dispose of gloves during meal service.

The department has determined the following as it relates to the allegations that staff do not ensure residents responsible parties are informed of epidemic outbreaks, that staff do not ensure resident records are maintained, and that staff do not ensure soiled gloves are properly discarded after use:

Based on review of facility records, review of resident records, interviews with S1-S8, and interviews with R2, R3, R4, and R6, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was left with Whinery.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2