455002677-11-6-2024-59-AS-KHOS-DB5JSU-20241118061851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002677
Report Date: 11/06/2024
Date Signed: 11/06/2024 01:25:42 PM

Unsubstantiated

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
10/04/2024 and conducted by Evaluator Sarah Benson

COMPLAINT CONTROL NUMBER: 59-AS-20241004083010

FACILITY NAME:	HALLMARK NORTH		FACILITY NUMBER:	455002677
ADMINISTRATOR:	SINGH, GURMEEL		FACILITY TYPE:	740
ADDRESS:	920 HALLMARK DR		TELEPHONE:	(530) 243-0147
CITY:	REDDING	STATE: CA	ZIP CODE:	96001
CAPACITY:	6	CENSUS: 6	DATE:	11/06/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Edward Eric Stadnicki Care Giver		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Personal Rights - Resident being sexually harrassed by another resident care.

INVESTIGATION FINDINGS:

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On 11/06/2024 at 1:00 PM Licensing Program Analyst (LPA) Sarah Benson, conducted an unannounced visit and met with Edward Eric Stadnicki Care Giver. The purpose of this visit was to deliver complaint findings.

During the complaint investigation staff and resident interviews were performed and the following documents were reviewed: staff list with telephone numbers, residents admission agreements, medical records, medication administration records, PRN medication records and incident reports.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Sarah Benson	TELEPHONE: 530-895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

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

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20241004083010

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: HALLMARK NORTH	FACILITY NUMBER: 455002677
	VISIT DATE: 11/06/2024

NARRATIVE

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Document review revealed, R1 chooses to walk to R2’s room. Documents reveal R1 chooses to spend time with R2. Documents reveal R1 gets anxious when unable to see R2. Documents reveal R1 has a new medication to treat this anxiety. Document review revealed staff redirect residents when found not in own room or when touching each other.

During Staff interviews it was reported that R1 gets anxious when unable to see R2. Staff reported R1 has gone to R2 room and climbed in bed with R2. When staff ask R1 to return to their own room R1 gets anxious and refuses. Staff reported the doctor has ordered anxiety medication to help R1 with anxiety concerning this matter. During staff interviews all staff stated R1 says R2 is their boyfriend.

During resident interviews R1 was asked how staff help them R1 stated the staff were nice to R1 and that she is “scared for their life.” When R1 was asked to tell more about being scared for her life R1 did not respond. When R1 was ask if anyone has done anything that bothers them, R1 responded no. When R1 was ask if R2 has done anything that bothers them they responded no. When R1 was ask if they felt safe R1 said “I do, no one has ever tried to hurt me or scare me.” It is noted that R1 has been diagnosed with dementia; however, appears to be able to vocalize what their needs are.

Based on investigation, observations, and interviews R1 has been found in R2 bed hugging and staff has returned R1 to own bed. The facility is taking action to keep the residents apart and discourage any type of inappropriate touching of one another. The facility has taken steps to supervise the residents closer so that either party is not receiving unwanted advances. Staff have reported when bathing a resident, it takes about ten minutes and that “takes my attention away from the other residents.” During interviews it has been discovered that R1 has not reported or indicated to staff that anyone has inappropriate touched them. It has been determined the clients are friendly toward one another with some physical contact, however there are no signs of sexual harassment. It was discovered that R1 seeks out R2 by choice and is anxious when unable to see R2. The facility has offered to move the residents but both POA’s have declined.

Based on the interviews conducted the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies cited. Exit interview conducted and a copy of the report was provided to Staff.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Sarah Benson	TELEPHONE: 530-895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC9099 (FAS) - (06/04)

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