392700475-1-18-2023-27-AS-KHOS-CN8QBL-20230119110142

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700475
Report Date: 01/12/2023
Date Signed: 01/18/2023 04:33:10 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
12/19/2022 and conducted by Evaluator Maja Jensen

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20221219094841

FACILITY NAME:	OAKS AT INGLEWOOD ASSISTED LIVING, THE		FACILITY NUMBER:	392700475
ADMINISTRATOR:	BRITTANY ANDREWS		FACILITY TYPE:	740
ADDRESS:	6725 INGLEWOOD AVE		TELEPHONE:	(209) 957-6257
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	86	CENSUS: 75	DATE:	01/12/2023
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Brittany Andrews		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are not following infection control protocol

INVESTIGATION FINDINGS:

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On 1/12/23 at approximately 9:35am Licensing Program Analyst Licensing (LPA) Maja Jensen arrived at facility unannounced to continue a complaint investigation in to the above listed allegation. LP Jensen met with Brittany Andrews and explained the purpose of the visit.

Prior to arrival LPA Jensen reviewed the facilitiesd COVID Mitigation Plan which was apprioved by the Department. Upon arrival LPA Jensen observed the front desk staff to be wearing a surgical mask incorrectly as it was not covering the staff member's nose. LPA Jensen observed a second staff member also not wearing their mask correctly. Based on a line list that was received LPA Jensen toured the facility with Administrator, LPA Jensen observed only one resident room with PPE outside of it. LPA Jensen came across staff 1 (S1) and asked for a donning and doffing demonstration which was performed in compliance with Public Health Department recommendations. LPA Jensen asked S1 how long COVID positive residents isolate for and was advised it was 7 days.
Continued on LIC 9099C...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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-20221219094841

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: OAKS AT INGLEWOOD ASSISTED LIVING, THE	FACILITY NUMBER: 392700475
	VISIT DATE: 01/12/2023

NARRATIVE

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LPA Jensen interviewed staff 2 (S2) who advised that the isolation period is 5 days for COVID positive residents who are asymptomatic. S2 also advised that COVID positive residents are not having temperatures checked.

The isolation periods given by staff are inconsistent with current guidance provided by CCLD on isolation time frames for COVID positive residents. In addition, the facility is not following their COVID mitigation plan with respect to monitoring COVID positive residents for symptoms and temperatures. The COVID positive residents also do not have identifying signs posted outside of their rooms so they can be easily identified. The allegation of staff not following COVID mitigation is SUBSTANTIATED. A finding of substantiated means that the preponderance of evidence standard has been met.

Deficiencies are being cited as a result of this complaint investigation from the California Code of Regulations (CCR) Title 22, Division 6. Failure to correct deficiencies may result in the assessment of civil penalties.

An exit interview was conducted and a copy of this report was given to the Executive Director.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20221219094841

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: OAKS AT INGLEWOOD ASSISTED LIVING, THE	FACILITY NUMBER: 392700475
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/12/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/19/2023 Section Cited CCR 87468.1	1 2 3 4 5 6 7	(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: ... (2) To be accorded safe, healthful and comfortable accommodations... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to distribute PIN 22-15.1 ASC and to enforce and follow the protocol specified in the facility's mitigation plan. Licensee will send an email to maja.jensen@dss.ca.gov with staff signatures by POC due date as evidence that this information has been disseminated to staff.
	8 9 10 11 12 13 14	Based on LPA's observation of staff wearing masks incorrectly and a lack of PPE and signage outside of COVID positive resident rooms. Also based on staff interviews showing inconsistent handling of resident monitoring and isolation times. This poses a potential threat to the health, safety and personal rights of residents in care.	8 9 10 11 12 13 14
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	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC9099 (FAS) - (06/04)

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