392700306-10-1-2020-27-AS-LKIG-BX2VSS-20210107154157

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700306
Report Date: 10/01/2020
Date Signed: 10/01/2020 11:52:52 AM

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
07/03/2020 and conducted by Evaluator Ruth Wallace

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200703142949

FACILITY NAME:	WAGNER HEIGHTS RESIDENTIAL		FACILITY NUMBER:	392700306
ADMINISTRATOR:	COLLINS, KATRICE		FACILITY TYPE:	740
ADDRESS:	2435 WAGNER HEIGHTS RD		TELEPHONE:	(209) 477-5353
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	80	CENSUS: 55	DATE:	10/01/2020
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Telephone Call with Katrice Collins - COVID-19 Pre-Cautions		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not administer medication as prescribed by physician.
Staff did not follow resident pre-admission appraisal regarding body transfers or modified diet as prescribed by physician.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Wallace contacted Administrator Katrice Collins on this day to conclude a complaint investigation via telephone due to COVID-19 and pre-cautionary measures. A physical visit was not conducted in that the Department is not conducting Residential Care for the Elderly visits at this time, due to the COVID-19 virus.
During the investigation, LPA Wallace conducted four staff interviews, family of resident, Administrator, Ombudsman, and the Complainant.
The first allegation is staff did not administer medication as prescribed by physician.
Facility did administer medications as prescribed for resident (R1) and had to contact doctor’s office at Kaiser multiple times in July of 2020 to get medications ordered or filled. Some of the medications that came from home were open and could not be used until refilled by Kaiser.
Based on interviews, LPA's observations, and records review, the Department (CCLD) has found the allegation of staff did not administer medication as prescribed by physician. Unsubstantiated.
A finding that the complaint allegation(s) is UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.
Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020

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-20200703142949

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: WAGNER HEIGHTS RESIDENTIAL	FACILITY NUMBER: 392700306
	VISIT DATE: 10/01/2020

NARRATIVE

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Continued from 9099

The Second allegation is staff did not follow resident pre-admission appraisal regarding body transfers or modified diet as prescribed by physician.

LPA reviewed in detail Medication logs, Physicians Orders, Incident Reports, Staff Notes, and Pre-Admission Appraisal. Facility did follow the pre-admission appraisal which reflected that resident (R1) could administer his own insulin and check blood sugar levels. No doctor's order for special diet, besides soft mechanical. Two person transfers were what facility staff followed, but there was no doctor's order for that as well. Staff would have to get another caregiver when transfers were needed for R1.

Based on interviews, LPA's observations, and records review; the Department (CCLD) has found the allegation staff did not follow resident pre-admission appraisal regarding body transfers or modified diet as prescribed by Physician. Unsubstantiated. A finding that the complaint allegation(s) is UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted with Administrator Katrice Collins via telephone and a copy of 9099, 9099-C, Appeal Rights, and 811(Confidential Names) was provided to Katrice via email, an electronic email read receipt confirms receiving these documents. Administrator will sign 9099, 9099-C, and send back electronic email to LPA Wallace on today's date.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020

LIC9099 (FAS) - (06/04)

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