347005713-9-12-2022-27-AS-KHOS-CJX4B4-20221005185656

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005713
Report Date: 09/12/2022
Date Signed: 09/12/2022 03:53:33 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/18/2022 and conducted by Evaluator Christina Valerio

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220518093355

FACILITY NAME:	DANIEL RESIDENTIAL CARE HOME LLC		FACILITY NUMBER:	347005713
ADMINISTRATOR:	DIALA, JOYCE		FACILITY TYPE:	740
ADDRESS:	4295 AMAPOLA WAY		TELEPHONE:	(916) 717-3263
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	6	CENSUS: 4	DATE:	09/12/2022
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Joyce Diala		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident sustained rashes while in care
Staff failed to meet resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christina Valerio contacted Administrator Joyce Diala via Teams Virtual Meeting and explained the reason for the meeting. LPA Valerio explained current complaint is being closed virtually due to the current Scabies outbreak at the facility.

The department has determined the following as it relates to the above-mentioned allegations. According to RP and S1, 2 out of 3 residents have had an undiagnosed rash since March of 2022. In accordance with those interviews, residents have been passing the rash back and forth between residents. R1’s rash was finally diagnosed on 8/17/2022, while in the hospital. According to interviews, continued requests made by CCL and RP, residents were not physically provided medical care regarding rash outbreaks.

Continues on LIC 9099 - C...

Substantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina Valerio	TELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

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

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20220518093355

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: DANIEL RESIDENTIAL CARE HOME LLC	FACILITY NUMBER: 347005713
	VISIT DATE: 09/12/2022

NARRATIVE

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S1 stated the Scabies outbreak started with a resident that is no longer at the facility. S1 stated the resident was at the facility for less than one month’s time. S1 stated there was no knowledge as to why the rash was being passed back and forth between residents.

Based on statements by staff, R2 has ongoing refused treatment, which has proposed a potential continued health and safety risk to the other residents in the facility. According to interview with S2, the length of time R2 has refused medical treatment for the outbreak has been approximately 5 months.

According to LPA Ivey Canady observations, staff did not ensure residents medical needs were properly addressed. According to interviews, licensee did not produce requested documentation to verify residents’ medical needs are addressed in a timely manner. Licensee stated residents had been taken to doctor’s appointments. Upon further investigation of those appointments, LPA Ivey Canady discovered those appointments were only phone consultations which required the licensee to follow-up with a dermatologist. According to records produced by the licensee, the residents had not been seen for this medical issue for over a month since the televisit. According to record review, a specialized dermatologist directed the care providers to take the residents in to see a specialist immediately. According to interviews, S1 and S2 did not follow doctors’ orders.

Based on interviews and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 6) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided.

An exit interview was conducted with Administrator Joyce. Administrator Joyce said the entire report is false and not true. Administrator Joyce said she is not going to sign anything or create any plan of correction. Administrator Joyce did not want to continue conversation with LPA unless a manager is present. LPA to set up an office meeting with licensee and Licensing Program Managers to discuss this matter.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina Valerio	TELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20220518093355

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: DANIEL RESIDENTIAL CARE HOME LLC	FACILITY NUMBER: 347005713
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/12/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied: Appeal Not Submitted Timely Type A 09/13/2022 Section Cited CCR 87468.1(a)(16)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (16) To receive or reject medical care or other services. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee refused to create a plan of correction with LPA Valerio. LPA Valerio will verify if deficiency is cleared on POC due date. Licensee refused to sign. On 09/13/22, Licensee signed hard copy.
	8 9 10 11 12 13 14	Based on observations, interview, and record review, residents sustained unidentified rash while in care. Diagnosis of rash was not confirmed until 5 months after onset of rash. This poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	This report was amended to show plan of correction created with licensee on 09/13/22. Licensee stated the facility will ensure all residents will receive medical care or other services. Licensee stated the facility will follow doctors orders and keep records for each resident in care. Licensee to send statement acknowledging review of 8746.1(a)(16).
Request Denied: Appeal Not Submitted Timely Type A 09/13/2022 Section Cited CCR 87465(a)(1)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed...:(1)The licensee shall arrange, or assist in arranging, for medical... care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee refused to create a plan of correction with LPA Valerio. LPA Valerio will verify if deficiency is cleared on POC due date. Licensee refused to sign. On 09/13/22, Licensee signed hard copy.
	8 9 10 11 12 13 14	Based on observations, interviews, and record review, the licensee did not obtain a plan for medical care regarding the rashes for 2 out of 3 residents. This poses an immediate health and safety risks to residents in care.	8 9 10 11 12 13 14	This report was amended to show plan of correction created with licensee on 09/13/22. Licensee stated they will document resident appointments, including follow up appointments. Licensee will send documentation via fax regarding scabies treatment and show when facility is cleared by public health.

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: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina Valerio	TELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC9099 (FAS) - (06/04)

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