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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002633
Report Date: 09/09/2020
Date Signed: 09/09/2020 12:50:11 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2020 and conducted by Evaluator Pheej Cheng
COMPLAINT CONTROL NUMBER: 25-AS-20200622103909
FACILITY NAME:A TOUCH OF HEAVENFACILITY NUMBER:
455002633
ADMINISTRATOR:PRATHER, SARAHFACILITY TYPE:
740
ADDRESS:760 KERRYJEN CTTELEPHONE:
(530) 226-5052
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:28CENSUS: 22DATE:
09/09/2020
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sarah PratherTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Care and Supervision - A resident arrived at the ER with a soiled diaper with dry fecal matter and excoriated skin.
INVESTIGATION FINDINGS:
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On 9/9/2020, Licensing Program Analyst (LPA) Cheng conducted an unannounced complaint investigation via telephone call regarding the allegation above. LPA spoke to Administrator Sarah Prather and explained the reason for the call. A telephone call was made in compliance with the department's procedures regarding COVID-19.

Based on documents and interview statements received, the department determined that there is insufficient information available. Multiple statements indicates that R1's diaper is changed every two hours or more as needed. Per S2 and S3's statements, R1's mental and physical condition on 6/21/2020 was not safe enough for a diaper change prior to being sent out to the hospital. S2 stated that R1's diaper was dry and did not need to be changed prior to being sent out to the hospital on 6/21/2020.
Continuation on LIC 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Pheej ChengTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2020
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 2
Control Number 25-AS-20200622103909
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: A TOUCH OF HEAVEN
FACILITY NUMBER: 455002633
VISIT DATE: 09/09/2020
NARRATIVE
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In regards to R1's excoriated skin, all individuals interviewed was aware of the pressure injury and R1 was utilizing Home Health Services. HHN confirmed that R1 had pressure injury and it was diagnosed as a stage 2 pressure injury. HNN confirmed that while HHN was providing services to R1, HHN did not see any lack in care and supervision from the facility. HNN also stated that HHN observed R1 to be in dry diapers and repositioned frequently during HHN's visits. LPA was unable to determine if pressure injury occurred while in facility's care.

Exit interview conducted. Two copies of report was given and LPA requested for Administrator to return a signed copy.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Pheej ChengTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2020
LIC9099 (FAS) - (06/04)
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