455001567-3-22-2022-25-AS-KHOS-CCYNQC-20220329103942

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455001567
Report Date: 03/22/2022
Date Signed: 03/22/2022 01:20:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/04/2022 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 25-AS-20220104091732

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:	03/22/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	SYE MAJID		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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A resident was not provided incontinent care.
There are unsafe conditions at the facility due to staff not being properly trained on how to work with dementia residents.
Residents are not receiving appropriate medications; staff are not reading orders from the physician.

INVESTIGATION FINDINGS:

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Donna Gurriere, Licensing Program Analyst was in contact and met with Sye Majid, Administrator. It was alleged that A resident was not provided incontinent care, There are unsafe conditions at the facility, due to staff not being properly trained on how to work with dementia residents, and Residents are not receiving appropriate medications; staff are not reading orders from the physician.

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.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

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 6

Control Number 25-AS-20220104091732

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A BRAND NEW DAY	FACILITY NUMBER: 455001567
	VISIT DATE: 03/22/2022

NARRATIVE

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During the investigation process, numerous documents were obtained and were reviewed depending on the allegation. Documents received and reviewed are as follows: Personnel Report, List of staff and resident names, correspondence to the Physician Assistant (PA), Medication Administrative Record (MARs), Medication Refill Request, Physician’s Report, Drug testing results, Staff corrective action report for incontinence, Relias Training Documents, Incident Reports, Training records and Contract Agreement for behavioral specialist facility.

A resident was not provided incontinent care.

The licensee, the administrator, several staff persons and a resident (Resident 1) were interviewed. In addition, records were reviewed.

It was reported that on 10/15/21 a staff person (S1) was given a written notice of a corrective action in that the staff person did not change two residents that were wet in urine. Documentation indicated that the staff person reported that “It had slipped her mind” in changing the residents. Staff person was terminated. Allegation is Substantiated.

Based on the evidence obtained, the preponderance of evidence standard has been met; therefore, the abovementioned allegation is found to be Substantiated. California Code of Regulations (Title 22) is being cited on the attached LIC 9099D. Appeal rights were provided, and the exit interview conducted.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC9099 (FAS) - (06/04)

Page: 6 of 6

Control Number 25-AS-20220104091732

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A BRAND NEW DAY	FACILITY NUMBER: 455001567
	VISIT DATE: 03/22/2022

NARRATIVE

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There are unsafe conditions at the facility, due to staff not being properly trained on how to work with dementia residents.

During the investigation process, the licensee, the administrator and six staff persons were interviewed. As mentioned above, documents were also obtained and reviewed to include New Employee Orientation Checklist, Relias Computer training and various training certificates

Several staff persons reported that they are unaware of unsafe conditions at the facility. Staff advised that they have had dementia training and have shadowed a more experienced staff person for the required 16-hour initial training. However, it was reported that some staff persons have not completed the required online training regarding dementia residents. Training requirement for dementia residents is Substantiated.

Based on the evidence obtained, the preponderance of evidence standard has been met; therefore, the abovementioned allegation is found to be Substantiated. California Code of Regulations (Title 22) is being cited on the attached LIC 9099D. Appeal rights were provided, and the exit interview conducted.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 25-AS-20220104091732

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A BRAND NEW DAY	FACILITY NUMBER: 455001567
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/22/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/29/2022 Section Cited CCR 87465(a)(1)	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 in obtaining such care, by compliance with the following: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.	1 2 3 4 5 6 7	The licensee/administrator agrees to develop a plan to ensure that this type of deficiency is avoided in the future. It was reported that the PA provided training to the staff. Plan of correction shall be completed and submitted to the licensing agency within two weeks.
	8 9 10 11 12 13 14	The licensee did not ensure that a resident was receiving his medication, as required.	8 9 10 11 12 13 14
	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: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 25-AS-20220104091732

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A BRAND NEW DAY	FACILITY NUMBER: 455001567
	VISIT DATE: 03/22/2022

NARRATIVE

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Residents are not receiving appropriate medications; staff are not reading orders from physician.

The licensee, the administrator and several staff persons were interviewed. In addition, records were reviewed.

It was reported and documents were reviewed to indicate that a resident (R1) did not receive his medication, as the resident had run out of prescription refills. The resident’s PA was contacted to request refill prescriptions for the resident. The resident went several days without his medication and it was reported that there had been medication errors. Allegation is Substantiated.

Based on the evidence obtained, the preponderance of evidence standard has been met; therefore, the above mentioned allegation is found to be Substantiated. California Code of Regulations (Title 22) is being cited on the attached LIC 9099D. Appeal rights were provided, and the exit interview conducted.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 25-AS-20220104091732

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A BRAND NEW DAY	FACILITY NUMBER: 455001567
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/22/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/29/2022 Section Cited CCR 87625(a)(1)(D)	1 2 3 4 5 6 7	Managed Incontinence The licensee shall be permitted to accept or retain a resident who has a manageable bowel and/or bladder incontinence condition under the following circumstances: The use of incontinent care products.	1 2 3 4 5 6 7	The licensee/administrator agrees to develop a plan to ensure that this type of deficiency is avoided in the future. Plan of correction shall be sent to the licensing agency within two weeks.
	8 9 10 11 12 13 14	The licensee did not ensure that managed incontinence care was provided to residents that needed incontinence care.	8 9 10 11 12 13 14
Type B 03/29/2022 Section Cited CCR 87707(a)(1)(C)	1 2 3 4 5 6 7	Training Requirements - Various methods of instruction may be used, including, but not limited to, presenters knowledgeable about dementia; video instruction tapes; interactive material; books; and/or other materials approved by organizations or individuals specializing in dementia.	1 2 3 4 5 6 7	The licensee/administrator agrees to have staff complete the online training courses. Plan of correction shall be sent to the licensing agency within two weeks.
	8 9 10 11 12 13 14	The licensee did not ensure that all staff had been trained with the online dementia training courses, as required.	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: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC9099 (FAS) - (06/04)

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