397202956-6-20-2024-27-AS-LKIG-D7GNCY-20240724102131

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397202956
Report Date: 06/20/2024
Date Signed: 06/20/2024 01:38:36 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
04/19/2024 and conducted by Evaluator Michael Bilger

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240419150205

FACILITY NAME:	CAMELLO HOME		FACILITY NUMBER:	397202956
ADMINISTRATOR:	CAMELLO, KIMBERLY B.		FACILITY TYPE:	735
ADDRESS:	2122 SHADY FOREST WAY		TELEPHONE:	(209) 467-3584
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95205
CAPACITY:	5	CENSUS: 4	DATE:	06/20/2024
		UNANNOUNCED	TIME BEGAN:	12:27 PM
MET WITH:	Pamela Alonzo		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

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Staff did not address resident's change of condition
Staff does not ensure resident has appropriate clothing
Staff are not meeting resident's toileting needs
Staff is not meeting resident's hygiene needs
Staff did not seek medical attention for resident
Resident is over medicated while in care

INVESTIGATION FINDINGS:

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On 6-20-24 at 12:27pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss findings for the complaint allegations noted above. LPA met with Administrator Pamela Alonzo and explained the purpose of the visit. Administrator of Record Kimberly Camello was notified via phone of LPAs visit and purpose. During this investigation, LPA conducted interviews with one resident, three staff members, and an additional witness. LPA also reviewed additional facility file documentation including admission agreement, professional care progress notes, hygiene logs, toileting log sheets, behavior tracking form, medication log sheets, appraisal form, functional capability assessment form, individualized program plan (IPP), physician’s report, and various email communications, all pertaining to resident1 (R1). Additionally, LPA conducted a facility observation on 5-9-24.

Allegation: Staff did not address resident’s change of condition. LPA conducted interviews and facility file reviews as noted above. {Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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 4

Control Number 27-AS-20240419150205

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: CAMELLO HOME	FACILITY NUMBER: 397202956
	VISIT DATE: 06/20/2024

NARRATIVE

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Based on review email communications, care progress notes, and interviews, it was indicated facility staff were in communication between R1’s regional center representative and physician between the dates of 3-12-24 and 4-23-24 to address elevated lithium levels and incontinent issues which included referrals to urology and endocrinology. Furthermore, it was revealed that medical needs were addressed on R1’s IPP and functional capabilities assessment. Interviews conducted revealed facility staff have addressed R1’s changes in condition and did not reveal any corroborated statements to counter this claim. As a result, there is not a preponderance of evidence to conclude staff did not address resident’s changes in condition, therefore, this allegation is UNSUBSTANTIATED.

Allegation: Staff does not ensure resident has appropriate clothing. LPA conducted interviews, record reviews, and facility observation as noted above. Based on observation conducted on 5-9-24, it was revealed R1 had in possession various clothing in adequate amounts and as appropriate for various seasons. Interviews conducted and professional progress notes further revealed R1 wears “loose flowy clothes…” as a matter of choice. Furthermore, interviews conducted did not reveal any corroborated statements of staff not ensuring appropriate clothing for residents in care. As a result, there is not a preponderance of evidence to conclude staff did not ensure appropriate clothing for residents during various periods of residency, therefore, this allegation is UNSUBSTANTIATED.

Allegation: Staff are not meeting resident’s toileting needs. LPA conducted interviews, facility observation, and record reviews as noted above. Based on review of R1’s toileting log sheets dated April-May 2024, it was indicated facility staff have documented consistently, and were instructed to check R1 every half hour to ensure monitoring for incontinent needs which included indication of type of care performed as needed. Interviews conducted did not reveal any corroborated statements of staff not meeting a resident’s toileting needs. Email communications between facility, regional center, and R1’s physician indicate an attempt to address incontinent care needs. Facility observation conducted did not reveal malodorous environments or visual evidence to indicate a lack of toileting care. As a result, there is not a preponderance of evidence to conclude staff are not meeting resident’s toileting needs, therefore, this allegation is UNSUBSTANTIATED.

{Cont. on 9099C}

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 27-AS-20240419150205

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: CAMELLO HOME	FACILITY NUMBER: 397202956
	VISIT DATE: 06/20/2024

NARRATIVE

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Allegation: Staff are not meeting resident’s hygiene needs. LPA conducted interviews, record reviews, and facility observation as noted above. Based on review of R1’s hygiene logs dated April-May 2024, it was indicated that facility staff have recorded instances of various hygiene acts performed by R1. This log sheet further reveals varying times of R1’s refusal to engage in hygiene. R1’s IPP further indicates intervention plans in place for hygiene which includes encouragement for completing hygiene tasks. Facility observation did not reveal any malodorous environments within facility. Facility observation did reveal adequate amounts of various grooming and hygiene supplies available to R1 and other residents. As a result, there is not a preponderance of evidence to conclude staff are not meeting resident’s hygiene needs. Therefore, this allegation is UNSUBSTANTIATED.

Allegation: Staff did not seek medical attention for resident. LPA conducted interviews and record reviews as noted above. Based on interviews conducted, it was revealed R1 has a urology and endocrinology appointment in place to address various on-going medical issues and associated interventions as warranted. It was further revealed through interviews that R1 has previously refused medical appointments. Email communications between facility, regional center, and medical provider reveal licensee has previously addressed R1’s medical issues on 3-12-24 including weight loss and bladder complications. Additional witness interview conducted on 5-29-24 revealed R1’s incontinent issues have improved since the assessment of R1’s lithium levels. Although it has been revealed R1 has existing medical issues, there is not a preponderance of evidence to conclude facility staff did not seek medical attention for resident, therefore, this allegation is UNSUBSTANTIATED.

Allegation: Resident is over medicated while in care. LPA conducted interviews and record reviews as indicated above. Based on review of medication log sheets and accompanying medication orders, it was revealed that facility staff assisted R1 with all prescribed medication as ordered during April and May 2024 with no refusals noted by R1. Medication log sheets matched medication orders and did not reveal any extra unprescribed medication available for R1 or indicated as given to R1. Interviews conducted did not reveal any corroborated statements of R1 being over medicated or receiving medication outside the boundaries of physician’s orders. As a result, there is not a preponderance of evidence to conclude resident is over medicated while in care, therefore, this allegation is UNSUBSTANTIATED.

{Cont. on 9099C}

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 27-AS-20240419150205

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: CAMELLO HOME	FACILITY NUMBER: 397202956
	VISIT DATE: 06/20/2024

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Pamela Alonzo and a copy of this report was provided to Pamela.. Appeal rights provided.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

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