455002633-11-20-2024-59-AS-KHOS-DBCHZS-20241125053851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002633
Report Date: 11/20/2024
Date Signed: 11/20/2024 10:37:31 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
08/05/2024 and conducted by Evaluator Ivan Avila

COMPLAINT CONTROL NUMBER: 59-AS-20240805143528

FACILITY NAME:	A TOUCH OF HEAVEN		FACILITY NUMBER:	455002633
ADMINISTRATOR:	PRATHER, SARAH		FACILITY TYPE:	740
ADDRESS:	760 KERRYJEN CT		TELEPHONE:	(530) 226-5052
CITY:	REDDING	STATE: CA	ZIP CODE:	96002
CAPACITY:	28	CENSUS: 17	DATE:	11/20/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Tricia Cockrum		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff do not ensure sufficient care and supervision is being provided to resident

INVESTIGATION FINDINGS:

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On 11/20/2024 Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegation directed by the Department. LPA met with Tricia Cockrum and explained the purpose of the visit.
During the investigation process, interviews and a records review were initiated.
LPA investigated the allegation, “Staff do not ensure sufficient care and supervision is being provided to resident.” Based on record review and interviews conducted, R1 had been found on the floor by staff in multiple occasions. Staff have stated it is unknown for how long R1 had been on the floor but was immediately helped back up and placed up on the bed or chair.

Based on LPAs interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation are found to be SUBSTANTIATED. California Code of Regulations, Title 22, and the California Health and Safety Code are cited on the attached LIC9099-D.
An exit interview was conducted, and a copy of the report and appeal rights were provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Ivan Avila	TELEPHONE: (559) 974-4915
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

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 59-AS-20240805143528

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: A TOUCH OF HEAVEN	FACILITY NUMBER: 455002633
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/20/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/22/2024 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs…sufficient support staff shall be employed to ensure provision of personal assistance. This requirement is not met as evidence by:	1 2 3 4 5 6 7	Facility will complete a statement of understanding regarding regulation 87411(a). Facility will submit statement of understanding via email to LPA by POC due date of 11/22/2024.
	8 9 10 11 12 13 14	Based on record review and interviews, the licensee did provide adequate care and supervision as R1 was found on the floor on multiple occasions, which posses an immediate Health, Safety, and/or Personal Rights risk to persons in care.	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: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Ivan Avila	TELEPHONE: (559) 974-4915
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
08/05/2024 and conducted by Evaluator Ivan Avila

COMPLAINT CONTROL NUMBER: 59-AS-20240805143528

FACILITY NAME:	A TOUCH OF HEAVEN		FACILITY NUMBER:	455002633
ADMINISTRATOR:	PRATHER, SARAH		FACILITY TYPE:	740
ADDRESS:	760 KERRYJEN CT		TELEPHONE:	(530) 226-5052
CITY:	REDDING	STATE: CA	ZIP CODE:	96002
CAPACITY:	28	CENSUS: 17	DATE:	11/20/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Tricia Cockrum		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff do not ensure residents hygiene care needs are being provided.
Staff did not ensure resident was accorded privacy while receiving incontinence care

INVESTIGATION FINDINGS:

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On 11/20/2024 Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegations directed by the Department. LPA met with Tricia Cockrum and explained the purpose of the visit.

During the investigation process, interviews and a records review were initiated.

LPA investigated the allegation, “Staff do not ensure residents hygiene care needs are being provided.” Based on interviews conducted, R1 had assistance with meals and daily services. There have been times staff assisted R1 in meals and R1 would use her hands to eat. It may appear that after meals R1s hygiene care was not being provided but staff would assist R1 in washing and cleaning R1’s hands with a damp cloth before being taken from the dining area.

****Continued on LIC9099-C****

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Ivan Avila	TELEPHONE: (559) 974-4915
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20240805143528

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: A TOUCH OF HEAVEN	FACILITY NUMBER: 455002633
	VISIT DATE: 11/20/2024

NARRATIVE

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LPA investigated the allegation, “Staff did not ensure resident was accorded privacy while receiving incontinence care.” Based on interviews conducted, there was no indication that any residents or staff observed that staff did not provide privacy to resident. During residents’ interviews, residents stated that facility staff are meeting their care needs and did not express any concerns with privacy or dignity. It was noted that they did not express any issues.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted, and a copy of the report and appeal rights was provided.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Ivan Avila	TELEPHONE: (559) 974-4915
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4