455001567-12-28-2022-25-AS-KHOS-CMRRXQ-20230104122508

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455001567
Report Date: 12/28/2022
Date Signed: 12/28/2022 09:58:41 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/25/2022 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 25-AS-20220425131651

FACILITY NAME:	A BRAND NEW DAY		FACILITY NUMBER:	455001567
ADMINISTRATOR:	TAYLOR, VERNA		FACILITY TYPE:	740
ADDRESS:	779 KERRY-JEN COURT		TELEPHONE:	(530) 223-1538
CITY:	REDDING	STATE: CA	ZIP CODE:	96002
CAPACITY:	26	CENSUS: 12	DATE:	12/28/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	STACEY MILLER		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Medication Error.
Staff did not obtain refill medication for resident.
Staff did not notice a change in resident's condition.

INVESTIGATION FINDINGS:

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Donna Gurriere, Licensing Program Analyst was in contact and met with Stacey Miller, Health Care Director, Administrator. It was alleged that the Facility is not seeking medical attention timely and the Facility is not dispensing medication as prescribed.

LPA Gurriere completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID 19 infection to affirm no COVID-19 related symptoms. The administrator/staff person was contacted to complete a facility risk assessment. LPA Gurriere ensured that hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. Additionally, LPA Gurriere was screened by a staff person upon entering the facility.

continued

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2022

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 10

Control Number 25-AS-20220425131651

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A BRAND NEW DAY	FACILITY NUMBER: 455001567
	VISIT DATE: 12/28/2022

NARRATIVE

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Medication Error.
During the investigative process, five staff persons were interviewed. An attempted interview was made with the resident (Resident 1); however, he did not engage in conversation. A walk-through of the facility was conducted whereas residents’ well-being was observed, and several records were reviewed. Various documents were obtained and reviewed to include Physicians Report, Admission Agreement, Appraisal and Needs, Medication Administration Records (MARs), Incident Reports, and a list of staff names.

On 04/29/22, the licensing agency received a copy of resident’s (Resident 1) Medication Administration Records (MARs), (21 pages). Upon review of the MARs, it was noted that several medications were discontinued during the months of December/January 2021. Medications include Aripiprazole, 2mg; Risperidone, 1mg; and Sertraline, 50mg. During the months of February/March 2022, medication was discontinued to include Levetiracetam, 500mg. The staff did not have a prescription order in place, as required to discontinue the medications; but rather received a verbal order.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be Substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D.

Appeal Rights were explained and provided to the facility representative listed above and an exit interview was conducted. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed.

continued

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 10

Control Number 25-AS-20220425131651

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A BRAND NEW DAY	FACILITY NUMBER: 455001567
	VISIT DATE: 12/28/2022

NARRATIVE

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Staff did not obtain refill medication for resident.
During the investigative process, five staff persons were interviewed. An attempted interview was made with the resident (Resident 1); however, he did not engage in conversation. A walk-through of the facility was conducted whereas residents’ well-being was observed, and several records were reviewed. Various documents were obtained and reviewed to include Physicians Report, Admission Agreement, Appraisal and Needs, Medication Administration Records (MARs), Incident Reports, and a list of staff names.

On 04/29/22, the licensing agency received a copy of the resident's MARs (21 pages). The MARs indicated that during the months of December/January 2021, the resident was without the medications of Quetiapine, 50mg and Trazodone 100mg. A review of the MARs indicates that the resident went without medication for approximately 10 days.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be Substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D.

continued

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 10

Control Number 25-AS-20220425131651

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A BRAND NEW DAY	FACILITY NUMBER: 455001567
	VISIT DATE: 12/28/2022

NARRATIVE

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Staff did not notice a change in resident's condition.
During the investigative process, five staff persons and a Community Care Licensing Staff person were interviewed. An attempted interview was made with the resident (Resident 1); however, he did not engage in conversation. A walk-through of the facility was conducted whereas residents’ well-being was observed, and several records were reviewed. Various documents were obtained and reviewed to include Physicians Report, Admission Agreement, Appraisal and Needs, Medication Administration Records (MARs), Incident Reports, and a list of staff names.

It was reported that the resident had a seizure and medical attention was not provided in a timely manner. On 04/28/22 licensing staff arrived at the facility to conduct a Case Management visit. Licensing staff observed the resident (Resident 1) lying on another resident’s bed shaking and shivering. Licensing staff asked the staff if the resident was “Okay,” as it appeared that the resident was having a seizure to them. After the licensing staff indicated concern for the resident, the staff contacted emergency services and the resident was sent out to the hospital. At least one licensing staff person indicated that staff did not notice a change in the resident’s condition and that there was a delay in contacting the emergency services.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be Substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D.

continued

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 10

Control Number 25-AS-20220425131651

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A BRAND NEW DAY	FACILITY NUMBER: 455001567
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/28/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/29/2022 Section Cited CCR 87465(e)	1 2 3 4 5 6 7	Incidental Medical - For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the	1 2 3 4 5 6 7	The licensee agrees to ensure that all prescribed and discontinued medications are written on a prescription order, as required. Licensee agrees to provide a plan of correction as to how to avoid this type of deficiency in the future.
	8 9 10 11 12 13 14	physician's order and the label shall contain at least all of the following information... The licensee did not ensure that this requirement was met as evidenced by interviews and observations. Medication errors were noted, and staff did not ensure that a written prescription order was on file for discontinued medications.	8 9 10 11 12 13 14	This is the second violation within a one-year period. Licensee shall be given civil penalties. Last citation was on 10/17/22.
Type A 12/29/2022 Section Cited CCR 87465(a)(6)	1 2 3 4 5 6 7	Incidental Medical and Dental Care – A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance… The licensee shall assist residents with self-administered medications as needed.	1 2 3 4 5 6 7	The administrator agrees to conduct an audit and review all medications of all residents in the facility to ensure that the licensee complies by having medications on site and in place for all residents. If the cited deficiency is not corrected by the noted due date; civil penalties may be assessed
	8 9 10 11 12 13 14	The licensee did not ensure that this requirement was met as evidenced by interviews and observations. Medications were not present in the facility for Resident 1, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	This is the second violation within a one-year period. Licensee shall be given civil penalties. Last citation was on 10/17/22.

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: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC9099 (FAS) - (06/04)

Page: 6 of 10

Control Number 25-AS-20220425131651

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A BRAND NEW DAY	FACILITY NUMBER: 455001567
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/28/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/29/2022 Section Cited CCR 87464(d)	1 2 3 4 5 6 7	Basic Services - A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible…	1 2 3 4 5 6 7	The licensee shall ensure that all staff have been trained in managing a resident’s care. Licensee shall provide a training plan to the licensing agency regarding seeking medical care in a timely manner.
	8 9 10 11 12 13 14	The licensee did not ensure that this requirement was met as evidenced by interviews and observations. A resident was having a seizure and the staff did not seek medical care in a timely manner.	8 9 10 11 12 13 14	This is the second violation within a one-year period. Licensee shall be given civil penalties. Last citation was on 09/26/22.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	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: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 10

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/25/2022 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 25-AS-20220425131651

FACILITY NAME:	A BRAND NEW DAY		FACILITY NUMBER:	455001567
ADMINISTRATOR:	TAYLOR, VERNA		FACILITY TYPE:	740
ADDRESS:	779 KERRY-JEN COURT		TELEPHONE:	(530) 223-1538
CITY:	REDDING	STATE: CA	ZIP CODE:	96002
CAPACITY:	26	CENSUS:	DATE:	12/28/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:			TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Resident sustained injury while in care.
Facility not providing medical reports to resident's medical professional.
Staff illegally evicted a resident.

INVESTIGATION FINDINGS:

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Donna Gurriere, Licensing Program Analyst was in contact and met with XXX, Administrator. It was alleged that the Facility is not seeking medical attention timely and the Facility is not dispensing medication as prescribed.

LPA Gurriere completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID 19 infection to affirm no COVID-19 related symptoms. The administrator/staff person was contacted to complete a facility risk assessment. LPA Gurriere ensured that hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. Additionally, LPA Gurriere was screened by a staff person upon entering the facility.

continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

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

LIC9099 (FAS) - (06/04)

Page: 7 of 10

Control Number 25-AS-20220425131651

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A BRAND NEW DAY	FACILITY NUMBER: 455001567
	VISIT DATE: 12/28/2022

NARRATIVE

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Resident sustained injury while in care.
During the investigative process, several staff persons were interviewed. An attempted interview was made with the resident (Resident 1); however, he did not engage in conversation. A walk-through of the facility was conducted whereas residents’ well-being was observed, and several records were reviewed. Various documents were obtained and reviewed to include Physicians Report, Admission Agreement, Appraisal and Needs, Medication Administration Records (MARs), Incident Reports, and a list of staff names.

On 02/04/22 Resident 1 was found to have sustained an unwitnessed fall out of a bed in another resident’s room. The resident was transported to the hospital and was treated for a 2 cm scalp laceration. It was noted that the resident was ambulatory and did not have a history of falls prior to the incident. File review documents did not document a history of fall, fall risk or one to one care for the resident. There was not a preponderance of evidence obtained to substantiate that the resident sustained a fall and subsequent injury due to a lack of care and supervision.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

continued

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC9099 (FAS) - (06/04)

Page: 9 of 10

Control Number 25-AS-20220425131651

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A BRAND NEW DAY	FACILITY NUMBER: 455001567
	VISIT DATE: 12/28/2022

NARRATIVE

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Facility not providing medical reports to resident's medical professional.
During the investigative process, five staff persons were interviewed. An attempted interview was made with the resident (Resident 1); however, he did not engage in conversation. A walk-through of the facility was conducted whereas residents’ well-being was observed, and several records were reviewed. Various documents were obtained and reviewed to include Physicians Report, Admission Agreement, Appraisal and Needs, Medication Administration Records (MARs), Incident Reports, and a list of staff names.

During the interview process, it was reported that the licensee and the health services coordinator were available to provide information to the resident’s medical professional (Physician’s Assistant). It was reported that there were numerous conversations with the PA regarding the care of Resident 1.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

Staff illegally evicted a resident.
During the investigative process, five staff persons were interviewed. An attempted interview was made with the resident (Resident 1); however, he did not engage in conversation. A walk-through of the facility was conducted whereas residents’ well-being was observed, and several records were reviewed. Various documents were obtained and reviewed to include Physicians Report, Admission Agreement, Appraisal and Needs, Medication Administration Records (MARs), Incident Reports, and a list of staff names.

continued

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC9099 (FAS) - (06/04)

Page: 10 of 10

Control Number 25-AS-20220425131651

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A BRAND NEW DAY	FACILITY NUMBER: 455001567
	VISIT DATE: 12/28/2022

NARRATIVE

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During the interview process, it was reported that the licensee was working with the licensing agency and the Ombudsman to have the resident moved, due to his outbursts and behavioral issues. The licensee had requested and was waiting for approval for a three-day eviction. It was reported that the resident had to wait in an ambulance for two hours; however, the previous health services coordinator was interviewed and she reported in a previous complaint allegation that when she heard that there was an issue with the resident in the ambulance, she went to the facility and admitted the resident back into the facility.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC9099 (FAS) - (06/04)

Page: 8 of 10