392700997-2-13-2023-27-AS-LKIG-CP5TRS-20230217135800

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700997
Report Date: 02/13/2023
Date Signed: 02/13/2023 04:31:12 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
01/17/2023 and conducted by Evaluator Maja Jensen

COMPLAINT CONTROL NUMBER: 27-AS-20230117141741

FACILITY NAME:	CAMLU ASSISTED LIVING		FACILITY NUMBER:	392700997
ADMINISTRATOR:	DIANE WRIGHT		FACILITY TYPE:	740
ADDRESS:	6037 N. PERSHING AVENUE		TELEPHONE:	(209) 951-2030
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	160	CENSUS: 51	DATE:	02/13/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Diane Wright		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency were not properly implemented by facility staff.

Reporting Requirement

INVESTIGATION FINDINGS:

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On 2/13/23 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue a complaint investigation in to the above listed allegations. LPA Jensen met with Executive Director Diane Wright and explained the purpose of today's visit.

LPA Jensen interviewed the Executive Director and determined that the facility endured a power outage twice during the course of the 2022/2023 Winter Storms. The first outage lasted approximately 54 hours between 12/31/22 and 1/2/23 and the second ouitage lasted approximately 24 hours on or aorund January 8, 2023. During the course of the first outage some familes of residents or resonsible parties were not notified of the outage. During the second outage that occured on or around 1/8/23, the facility reached out to the listed emergency contact person for each resident. Community Care Licensing was not notified by facility staff that the power outage had occured during either incident but was made aware of the power outage by a concerned party.
Continued on LIC 9099....

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: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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-20230117141741

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: CAMLU ASSISTED LIVING	FACILITY NUMBER: 392700997
	VISIT DATE: 02/13/2023

NARRATIVE

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The allegation of reporting requirement non-compliance is SUBSTANTIATED based on LPA Jensen's determination that the Community Care Licensing Department did not receive a timely written report of outage which qualifies as an incident that threatens the welfare, safety or health of any resident. A finding of substantiated means the preponderance of evidence standard has been met.

LPA Jensen also reviewed the LIC 610E. The facility's approved Emergency Disaster Plan was last updated 1/4/23 and has been reviewed by 7 staff members including the Executive Director, Dietary Director, Resident Care Director, Resident Care Coordinator and Administrative staff. Under the LIC 610E Sheltering Place subsection specific to self reliance for periods of not less than 72 hours immediately following any emergency or disaster, including but not limited to , a short term or long term power failure it stipulates that in the event of a long term power outage "families will be notified to see if they want to bring the resident home, if needed we would relocate to sister community (Orangeburg). During the course of the first power outage, approximately 25% if the resident families were not contacted to be given the option of bringing the resident home. In addition, the LIC 610E indicates a plan to "contract with outside company to provide us with generator if power to be off for a few days. The Executive Director advised that while an outside vendor was contacted for potentially supplying a back up generator there was no 3rd party vendors available at the time due to such a large region being affected by outages. The Executive Director also advised that the facility's electrical panel is not adequately equipped for back up generator purposes however the faciloty is currently in the process of upgrading the electrical system. Based on LPA Jensen's review of the LIC 610E and interviews conducted the allegation of Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency were not properly implemented by facility staff is SUBSTANTIATED. A finding of substantiated means the preponderance of evidence standard has been met.

Deficiencies are being cited from the California Code of Regulations (CCR) and Health and Safety Code (HSC). Failure to correct deficiencies may result in the assessment of civil penalties.

An exit interview was conducted and a copy of this report and appeal rights were given.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230117141741

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: CAMLU ASSISTED LIVING	FACILITY NUMBER: 392700997
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/17/2023 Section Cited CCR 87211(a)(1)(D)	1 2 3 4 5 6 7	Reporting Requirements ...A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified...Any incident which threatens the welfare, safety or health of any resident...This requirement was not as evidenced by:	1 2 3 4 5 6 7	Licensee will send an attestation that a plan has been implemented to notify the Department of any power outages or potential evacuations by Plan of Correction due date and will email the attestation to LPA Jensen.
	8 9 10 11 12 13 14	Based on LPA Jensen's verification through interviews and review of submitted incident reports that the power outage was not reported to the Department as required. This poses a potential health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14
Type B 02/17/2023 Section Cited HSC 1569.695(a)(7)	1 2 3 4 5 6 7	Emergency Plans ...a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: ...Residents and their responsible parties shall be informed of the process for communicating during an emergency. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee will send an attestation that a plan has been implemented to notify the resident's responsible paries of any power outages or potential evacuations by Plan of Correction due date and will email the attestation to LPA Jensen.
	8 9 10 11 12 13 14	Based on interviews conducted and a review of the LIC 610E the facility has a plan to notify families of emergency or disaster occurrences and this did not occur for every resident during the power outage from 12/31/23-1/2/23. This poses a potential risk to the health, safety and personal rights of residents in care.	8 9 10 11 12 13 14

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: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC9099 (FAS) - (06/04)

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