455002633-3-20-2023-25-AS-KHOS-CQDHJ4-20230329061342

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002633
Report Date: 03/20/2023
Date Signed: 03/20/2023 10:39:06 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2022 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 25-AS-20220919110920

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: 15	DATE:	03/20/2023
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	SARAH PRATHER		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not seek timely medical attention for a resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Donna Gurriere and Sarah Benson, Licensing Program Analysts (LPAs) were in contact and met with Sarah Prather, Administrator.

LPA Gurriere and LPA Benson 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: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

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 5

Control Number 25-AS-20220919110920

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: A TOUCH OF HEAVEN	FACILITY NUMBER: 455002633
	VISIT DATE: 03/20/2023

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

During the interview process, several staff persons were interviewed. The resident was not interviewed, as he has since passed. An attempt was made to interview the hospice nurse; however, she did not return the call. Various documents were obtained and reviewed to include Physicians Report, Admission Agreement, Appraisal and Needs, Incident Reports, and a list of staff names.

During the investigation process, it was reported that the resident was on hospice. It was stated that the resident was fairly young (in his 60s) and that he had a propensity to get out of bed, as he was physically able to do so. The resident attempted to get out of bed and the staff person on shift heard the resident fall. The staff person went to the resident’s aid to assist. Shortly thereafter, two other staff arrived to assist with the resident. It was stated that since the resident was on hospice, the protocol was to contact that hospice nurse for an evaluation. It was reported that it took the hospice nurse nearly 45 minutes to arrive at the facility. The resident sustained a wound to the head and was bleeding. Once the hospice nurse arrived, she then made contact with the resident’s daughter to see if “they” should contact emergency services.

Although the resident did not sustain a serious injury, the staff should have contacted emergency services and had the paramedics assist in determining the resident’s need for hospitalization. When the paramedics did arrive, it was determined that the resident did need medical attention and was taken to the hospital. The resident did not get medical attention in a timely manner.

Based on investigation 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 date; civil penalties may be assessed.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 25-AS-20220919110920

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: A TOUCH OF HEAVEN	FACILITY NUMBER: 455002633
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/21/2023 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 for meeting the resident's needs as identified in the pre-admission appraisal…	1 2 3 4 5 6 7	The administrator agrees to submit a policy to the licensing agency advising how this type of citation will be avoided in the future.
	8 9 10 11 12 13 14	The licensee did not ensure that the resident received medical attention in a timely manner.	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: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2022 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 25-AS-20220919110920

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:	DATE:	03/20/2023
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	SARAH PRATHER		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Neglect/Lack of supervision resulted in a resident sustaining an injury due to a fall.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

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 5

Control Number 25-AS-20220919110920

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: A TOUCH OF HEAVEN	FACILITY NUMBER: 455002633
	VISIT DATE: 03/20/2023

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

During the interview process, several staff persons were interviewed. The resident was not interviewed, as he has since passed. An attempt was made to interview the hospice nurse; however, she did not return the call. Various documents were obtained and reviewed to include Physicians Report, Admission Agreement, Appraisal and Needs, Incident Reports, and a list of staff names.

During the investigation process, it was reported that the resident was on hospice. It was stated that the resident was fairly young (in his 60s) that the resident was independent and had a propensity to get out of bed, as he was physically able to do so. The resident attempted to get out of bed and the staff person on shift heard the resident fall. The staff person immediately went to the resident’s aid to assist. Shortly thereafter, two other staff arrived to assist with the resident. Staff reported that they did everything that they could do to assist the resident with his mobility. The resident was physically capable of walking; however, at times he would have difficulty due to his diagnosis. There was not a lack of supervision in that there were three staff persons that were available to assist the resident when he fell.

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: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5