347005512-4-15-2024-27-AS-KHOS-D4LNLE-20240423103325

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005512
Report Date: 04/15/2024
Date Signed: 04/15/2024 01:20:17 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
02/08/2024 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240208123439

FACILITY NAME:	IVY PARK AT LAGUNA CREEK		FACILITY NUMBER:	347005512
ADMINISTRATOR:	MORGAN WHINERY		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:	04/15/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Michelle Swearingen		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Staff did not administer resident's medication as prescribed.
Facility does not have sufficient staff to meet residents' needs.

INVESTIGATION FINDINGS:

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

This investigation consisted of interviews, observation, and record review. LPA Moleski interviewed Swearingen, 17 staff members (S1-15, S17-S18), nine residents (R2-R10), and a former resident’s responsible party (R1’s RP).

LPA Moleski reviewed R1’s medical records, medication prescriptions, and three months’ worth of medication administration records (MARs). LPA Moleski did not observe any indication of medication mismanagement in these records.

[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: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

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 27-AS-20240208123439

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: IVY PARK AT LAGUNA CREEK	FACILITY NUMBER: 347005512
	VISIT DATE: 04/15/2024

NARRATIVE

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In an interview, R1’s RP described an incident wherein a former staff member (S16) refused to provide PRN medication to R1. R1’s RP said that S15 witnessed the incident. In an interview, S15 said S15 had not witnessed any incident wherein S16 refused to provide medication to R1 without good cause, and had not witnessed any disagreement regarding medication between R1’s RP and S16. S15 said R1’s RP had often asked for R1’s medication during time periods in which the resident was not to receive additional doses, per R1’s prescriptions. Several other staff members (S1, S2, S5, S9, S13) reported experiencing similar incidents with R1’s RP. No other staff members interviewed were aware of an incident wherein S16 refused to provide medication to R1. LPA Moleski attempted to contact S16. Both phone numbers for S16 on file were inactive.

Eleven caregivers and medication technicians (S5-S15) were interviewed regarding staffing levels at this facility. Among these 11, four staff members voiced concerns about the current staffing levels. S5 reported no problems meeting all residents’ needs. S6 said the cottage S6 works in is well staffed and reported no issues. S7 said S7 was able to meet all residents’ needs with the current staffing levels, although sometimes it takes a while to complete all tasks. S8 said S8 was able to meet all residents’ needs. S9 said staff were not overworked and were able to complete all tasks. S10 said sometimes medication technicians must pass medications in three cottages, and during those times they are short-staffed. S11 said S11 needs additional assistance from a medication technician when caring for a bedridden resident, but said all care needs were met. S12 said staffing was not sufficient during mealtimes, which are very busy. S12 said S12 was able to meet all residents’ care needs. S13 said the facility is short staffed during the lunch hour, but said all care needs were being met. S14 said current staffing levels were sufficient. S15 said staffing was sufficient provided that the right staff members were on shift. S15 said all care needs were being met.

Among the nine residents interviewed, four voiced concerns regarding current staffing levels. R2 said all R2’s needs were met and felt staffing was sufficient. R3 said there were enough staff to meet R3’s needs. R5 was not sure if the facility was understaffed, but said R5’s needs were being met. R9 said that R9’s needs were being met and said there were enough staff. R10 said R10’s needs were being met and did not voice concerns regarding staffing or regarding care received at the facility.

[continued on 9099-C]

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20240208123439

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: IVY PARK AT LAGUNA CREEK	FACILITY NUMBER: 347005512
	VISIT DATE: 04/15/2024

NARRATIVE

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In an interview, R4 said that the facility was understaffed, and said staff had not offered to shower R4 for four days. LPA Moleski reviewed a shower schedule which showed R4 receives two showers a week. LPA Moleski interviewed three staff members, (S1, S17, and S18). S1 said R4 had been refusing care. S17 said R4 had been weak and unable to transfer. S18, who was present on R4’s scheduled shower day, said R4 was in pain and unable to transfer for the shower. During the same interview, R4 said that staff have made her wait for toileting assistance, but staff typically respond to R4’s call button, and are typically supportive of her needs.

In interviews, R6-R8 said that the facility was understaffed due to lack of timely response to calls for assistance. LPA Moleski reviewed response times for a period of 30 days for R4, R6, R7, and R8. LPA Moleski observed average response times of 14 minutes and 41 seconds for R8 and 9 minutes and 32 seconds for R7. R4 and R6 did not press their pendants during the 30-day period reviewed. Previous records were not available.

LPA Moleski reviewed staffing schedules and resident rosters. LPA Moleski observed that four of the five operational cottages are typically staffed with two caregivers each. The fifth is typically staffed by one or two caregivers. This fifth cottage was inhabited by seven residents at the onset of this investigation. The remaining four cottages were inhabited by 11 to 15 residents each. Medication technicians are typically assigned to cover two to three cottages each. Based on interviews, medication technicians assist with direct care of residents when needed.

LPA Moleski visited this facility to investigate this complaint on 2/14/24, 3/11/24, 4/11/24, and 4/15/24. During these visits, residents observed appeared healthy and clean. LPA Moleski observed residents in common areas being supervised by staff members.

The department has determined the following as it relates to the allegations that staff did not administer a resident's medication as prescribed, and that the facility does not have sufficient staff to meet residents' needs: Based on interviews, observation, and record review, 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 held and a copy of this report was left with Swearingen.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

LIC9099 (FAS) - (06/04)

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