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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803570
Report Date: 12/24/2020
Date Signed: 12/24/2020 12:50:14 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/21/2020 and conducted by Evaluator Karina Canela
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20200821155657
FACILITY NAME:LOVING PLACEFACILITY NUMBER:
486803570
ADMINISTRATOR:RAJWANT MINHASFACILITY TYPE:
740
ADDRESS:2429 HANCOCK DRIVETELEPHONE:
(707) 628-4451
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: 5DATE:
12/24/2020
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH: Rajwant "Goldie" MinhasTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff fails to execute emergency disaster plan
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) K. Canela contacted Loving Place by phone and spoke with Rajwant "Goldie" Minhas, on 12/24/2020 for the purpose of delivering findings on complaint # 21-AS-20200821155657. Due to COVID – 19 precautions a facility visit is not able to be conducted at this time.
The Department investigated the allegation "Staff fails to execute emergency disaster plan”. Interviews were conducted with 5 of 5 facility staff on 08/28/2020 and 09/21/2020. A record review was conducted of: Resident’s records, medical physician's reports, staff records, credit card statements, the facility’s plan of operation, the facility’s Emergency and Disaster Plan, as well as a record review of the facility file was completed.

Report continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: (707) 588-5083
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020
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 7
Control Number 21-AS-20200821155657
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: LOVING PLACE
FACILITY NUMBER: 486803570
VISIT DATE: 12/24/2020
NARRATIVE
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Loving Place Facility is licensed for a capacity total of 6 non-ambulatory residents of which 1 may be bedridden. An individual who is non-ambulatory is unable to leave a building unassisted under emergency situations which includes, but is not limited to, a dependence on assistive devices such as crutches, walkers, and/or wheelchairs. It also includes individuals who are unable, or likely to be unable, to respond physically or mentally to an oral instruction unassisted or take appropriate action relating to an emergency (i.e. fire). According to the resident’s Medical Physician reports (form LIC 602), 4 of 4 residents are non-ambulatory due to mental and physical impairments (requiring an assistive device, such as a walker or wheelchair).

On 08/19/2020, Evacuations were ordered in Solano County, northwest Vacaville and the outskirts of Fairfield due to the LNU Complex Fire. Traffic on the eastbound lanes of Interstate 80 stopped and several exits were blocked off due to the fire. There were 2 direct care staff (S2 & S3) and 1 maintenance staff (S6) on shift at the facility on 08/19/2020. The Department initiated a complaint investigation on 08/28/2020 into the allegation involving the facility staff who failed to execute the facility Emergency and Disaster Plan to evacuate residents in care. The Department conducted interviews with 5 facility staff, Emergency Dispatch services, Kindred Hospice Care, and other witnesses regarding the evacuation due to the LNU Complex Fire.

Statements received from Staff (S1) indicated that on the morning of 08/19/2020, the LNU Complex Fire had not reached the area near the facility and was active across the freeway. At the time, an evacuation order in the area had not been initiated. S1 stated staff in the facility were preparing “emergency supplies including medications, oxygen, paperwork, personal belongings of residents & wheelchairs etc. All staff were prepared …” to evacuate. Resident’s families were notified of the situation and the facility’s plan of evacuation was “discussed with all the families and Hospice care nurse… around 10-11 am” according to S1. Additionally, S1 stated they requested oxygen supplies from Kindred Hospice for R1. S1 stated R1 had “one oxygen cylinder and … extra oxygen can be delivered within 2 hours if needed” by Kindred Hospice services. S1 stated they visited the facility multiple times throughout the day to check on staff and residents, stating “everything was normal and there was no issue with safety of residents”.

Report continued on LIC 9099-C

SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: (707) 588-5083
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 21-AS-20200821155657
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: LOVING PLACE
FACILITY NUMBER: 486803570
VISIT DATE: 12/24/2020
NARRATIVE
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S1 proceeded to leave the facility at approximately 4:50 PM and observed Licensee (S5) “driving to the care home about 2 blocks away”. S1 stated S5 dropped off groceries to the facility at approximately 4:55 PM and asked staff to be vigilant, though a mandatory evacuation order had not been issued at that time. At approximately 5:45 PM – 6:00 PM, S1 received a text message notification on their cell phone of an evacuation order for the area where the facility resides. The facility is located about 2.9 miles (approximately a 6-minute drive) away from the Licensee’s home. S1 instructed staff “to call 911 for evacuation assist” as S1 was stuck in traffic driving to the facility in their SUV to assist staff with the evacuation. S1 stated they were stopped by Vacaville Police Officers at the intersection of Peabody Rd and Foxboro pkwy due to a Police roadblock. S1 stated Vacaville Police Officers would not allow S1 to take a left turn into Fairfield due to the fire evacuation order and was instructed to use Vanden Rd instead. S1 proceeded to go through Vanden Rd and arrived at the intersection of Peabody and Vanden, but the Fairfield Police Officer would not allow S1 to take a right turn to get to the facility (due to the fire evacuation order). S1 stated they explained to Vacaville and Fairfield Police Officers that they needed to reach Loving Place Facility to assist with the evacuation of their residents and staff. The facility is located directly across the street from a “dry hill” area where the fire was approaching.

S1 stated 2 residents (R1 & R2) were evacuated via ambulance and transported to NorthBay Vacavalley Hospital and Vacaville Kaiser Hospital. Statements from witnesses and staff revealed R1’s family member was at the facility on 08/19/2020 to assist with evacuating R1. Staff reportedly relied on R1’s family member to locate a hotel to accommodate and relocate residents to. S1’s credit card statements and hotel receipts indicated S1 and Licensee booked 2 rooms at a hotel in Sacramento to accommodate 2 of 4 residents. A statement from S1 revealed that after residents and staff were evacuated safely, S1 notified all resident families and then contacted Kindred Hospice, who informed S1 that all residents under Kindred Hospice services were evacuating to nearby Hospitals.

Interviews conducted with Kindred Hospice revealed R1 used their emergency Oxygen tank and S1 contacted Kindred Hospice to restock R1’s oxygen tank supply. However, due to the fire in the area and the oxygen restock company being “30 minutes out due to the fires”, R1 would have been without an oxygen supply for approximately 1 hour or more. Therefore, Kindred Hospice advised R1 be transported to a nearby Hospital. Statements obtained from Kindred Hospice services indicated procedures for evacuation in an emergency depend on the hospice patient, which can involve transporting the resident to a hospital, to a resident’s family member’s home, or to a Skilled Nursing Facility.

Report continued on LIC 9099-C

SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: (707) 588-5083
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 21-AS-20200821155657
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: LOVING PLACE
FACILITY NUMBER: 486803570
VISIT DATE: 12/24/2020
NARRATIVE
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Interviews revealed Loving Place Facility “did not have a means to evacuate; their plan was to call 911” instead. Statements obtained from Emergency Services revealed ambulances were limited to medical emergencies due to the high volume of 911 calls in the area involving the LNU Complex Fire. Statements revealed facility staff/caregiver contacted 911 to evacuate all 4 residents and 3 staff from the facility in 1 ambulance vehicle. Emergency Medical Technicians (EMT) assessed the residents and determined one resident (R1), who was on hospice and with a respiratory medical complaint (low oxygen saturation), could be evacuated via ambulance. Statements revealed staff on shift did not have a plan of where to transport R1 and suggested R1 be transported to a nearby evacuation center. EMTs stated (to the facility staff) that they would not transport and leave R1 at an evacuation center. Additionally, stating R1 could only be transported to a Hospital, as the ambulance services are only available to individuals to be taken to the Hospital for medical emergencies/complaints. EMTs stated they could not evacuate 7 individuals (4 residents and 3 staff) in the ambulance and staff should transport the other residents in the staff’s (S2) car. EMTs statements revealed staff were calling 911 to attempt to evacuate an additional resident in a wheelchair by ambulance as EMTs were leaving the scene with R1.

Statements indicated that on 08/29/2020 there was one car at the facility belonging to staff (S2), which interviews revealed the car was low on gasoline. Additionally, interviews revealed S2 was reluctant to evacuate any residents and/or other staff on shift due to the maximum seating capacity of their car and insufficient gasoline. S2’s car was reportedly described as a “small 5-seater Honda” and may have had personal items in the car which further added to the issue of available space for seating staff and residents. Staff interviews indicated 2 residents use wheelchairs and 2 residents use walkers. In addition, witnesses stated 4 residents and 3 staff (for a total of 7 persons) as well as 2 wheelchairs, 2 walkers and resident (R1)’s oxygen tank(s) would not have been able to safely fit in S2’s car to evacuate. The facility’s Emergency and Disaster Plan for Residential Care Facilities for the Elderly indicated on page 5 of 9, Evacuation Procedures under section Identify transportation needs states: “The administrator and the administrator designee will use their personal vehicles for transportation, in case of an emergency”. Based on information received, staff did not properly engage the Facility’s Evacuation Procedure due to: staff (S2) not wanting to utilize their car to evacuate residents; Licensee arrived at the facility to drop off groceries earlier that day and left the facility; and Administrator was unable to reach the facility in a timely manner due to Police roadblocks.

Based on LPA's observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the allegation “Staff fails to execute emergency disaster plan” is found to be SUBSTANTIATED.

California Code of Regulations, (Title 22, Division 6 Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted with Rajwant "Goldie" Minhas, Administrator, who's signature below confirms receipt of this report. Appeal Rights Provided

SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: (707) 588-5083
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/21/2020 and conducted by Evaluator Karina Canela
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20200821155657

FACILITY NAME:LOVING PLACEFACILITY NUMBER:
486803570
ADMINISTRATOR:RAJWANT MINHASFACILITY TYPE:
740
ADDRESS:2429 HANCOCK DRIVETELEPHONE:
(707) 628-4451
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: 5DATE:
12/24/2020
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH: Rajwant "Goldie" MinhasTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff unlawfully discharging residents while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) K. Canela contacted Loving Place by phone and spoke with Rajwant "Goldie" Minhas, on 12/24/2020 for the purpose of delivering findings on complaint # 21-AS-20200821155657. Due to COVID – 19 precautions a facility visit is not able to be conducted at this time.

The Department investigated the allegation "Staff unlawfully discharging residents while in care”. Interviews were conducted with 5 of 5 facility staff on 08/28/2020 and 09/21/2020. A record review was conducted of: Resident’s records, medical physician's reports, staff records, credit card statements, the facility’s plan of operation, the facility’s Emergency and Disaster Plan, as well as a record review of the facility file was completed.

Report continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: (707) 588-5083
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 21-AS-20200821155657
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: LOVING PLACE
FACILITY NUMBER: 486803570
VISIT DATE: 12/24/2020
NARRATIVE
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On 08/19/2020, Evacuations were ordered in Solano County, northwest Vacaville and the outskirts of Fairfield due to the LNU Complex Fire. Traffic on the eastbound lanes of Interstate 80 stopped and several exits were blocked off due to the fire. There were 2 direct care staff (S2 & S3) and 1 maintenance staff (S6) on shift at the facility on 08/19/2020. The Department initiated a complaint investigation on 08/28/2020 into the allegation "Staff unlawfully discharging residents while in care". The Department conducted interviews with 5 facility staff, Emergency Dispatch services, Kindred Hospice Care, and other witnesses regarding the evacuation due to the LNU Complex Fire.

Statements obtained from Emergency Services revealed ambulances were limited to medical emergencies due to the high volume of 911 calls in the area involving the LNU Complex Fire. Statements revealed facility staff/caregiver contacted 911 to evacuate all 4 residents and 3 staff from the facility in 1 ambulance vehicle. Emergency Medical Technicians (EMT) assessed the residents and determined one resident (R1), who was on hospice and with a respiratory medical complaint (low oxygen saturation), could be evacuated via ambulance. Statements revealed staff on shift did not have a plan of where to transport R1 and suggested R1 be transported to a nearby evacuation center. EMTs stated (to the facility staff) that they would not transport and leave R1 at an evacuation center; R1 was then transferred to Vacaville Kaiser Hospital.

Thereafter, R1 did not return to Loving Place Facility and was transferred to a Skilled Nursing Facility (SNF). An interview revealed R1 had previous arrangements to be admitted to a SNF due to decline in health, resulting in"becoming total care". Additionally, Interviews indicated Loving Place Facility's evacuation "did not go as planned" and R1 "had really good care there [Loving Place]".

Although the allegation "Staff unlawfully discharging residents while in care" may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED

Exit interview conducted with Rajwant "Goldie" Minhas, Administrator, who's signature below confirms receipt of this report.

SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: (707) 588-5083
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2020
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 21-AS-20200821155657
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: LOVING PLACE
FACILITY NUMBER: 486803570
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/11/2021
Section Cited
HSC
1569.625(c)(6)
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§1569.625 (c)(6) Staff training; legislative findings; contents - (c) The training shall include...(6) Building and fire safety and the appropriate response to emergencies.
This requirement has not been met as evidenced by:
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Administrator to submit to Community Care Licensing (CCL) a detailed addendum to Loving Place's Emergency and Disaster plan addressing Evacuation Procedures - Transportation. Administrator to submit proof of Emergency and Disaster training of All staff (including S6) to CCL.
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Staff (S2,S3,S6) on duty during fire evacuation were not trained to execute Facility Emergency and Disaster Plan. This poses a potential Health and Safety risk to residents in care
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Proof of Emergency and Disaster training of staff to include date, time, detailed content, duration, and staff name & signatures. Addendum and proof of training to be submitted by POC date in order to clear the deficiency.
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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: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: (707) 588-5083
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2020
LIC9099 (FAS) - (06/04)
Page: 7 of 7